Screening and monitoring of latent tubercular infection in patients taking tumor necrosis factor-α blockers for psoriatic arthritis

J Rheumatol Suppl. 2012 Jul:89:82-5. doi: 10.3899/jrheum.120252.

Abstract

Patients with arthritis who need treatment with biologics are carefully screened for possible previous exposure to tuberculosis to detect any latent tubercular infection (LTBI). The traditional method of screening for LTBI is not specific, because positivity could also depend on infection by atypical mycobacteria and bacillus Calmette-Guerin vaccination. In addition, the screening does not show high sensitivity, frequently presenting a false negativity because of immunosuppression caused by drugs used for arthritis. Recently, interferon-γ release assays (IGRA) have been used to screen LTBI with more sensitivity and specificity before treatment with anti-tumor necrosis factor-α drugs. Moreover, in our experience, IGRA are potentially useful in monitoring LTBI during biologic therapy.

MeSH terms

  • Anti-Inflammatory Agents / adverse effects*
  • Arthritis, Psoriatic / complications
  • Arthritis, Psoriatic / drug therapy*
  • Arthritis, Psoriatic / immunology
  • Drug Monitoring
  • Humans
  • Interferon-gamma Release Tests*
  • Latent Tuberculosis / complications
  • Latent Tuberculosis / diagnosis*
  • Latent Tuberculosis / microbiology
  • Mass Screening / methods*
  • Mycobacterium tuberculosis / pathogenicity
  • Patient Selection
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Time Factors
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Tumor Necrosis Factor-alpha / metabolism

Substances

  • Anti-Inflammatory Agents
  • Tumor Necrosis Factor-alpha