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Master thesis

Diagnostic de tuberculose latente chez des patients atteints de rhumatisme inflammatoire chronique candidats à une biothérapie : facteurs infuençant le résultat d'un test de libération d'interféron gamma (T-SPOT.TB®)

Abstract : Screening for latent tuberculosis infection (LTBI) is mandatory before initiating TNF-alpha blocker treatment. Use of interferon gamma release assay (IGRA) for the screening seems interesting but has not been validated. The aim of our study was to identify factors that may influence IGRA results in this situation. 590 patients with rheumatoid arthritis (49,8%), spondyloarthritis (45,9%) or other inflammatory rheumatism (4,2%) and eligible for biologic treatments have been consecutively recruited. A chest X-ray, a tuberculin skin test (TST) and an IGRA (T-SPOT.TB®;) were performed for each patient. 78% were vaccinated with BCG. 21,2% of T-SPOT.TB®; were positive, 63% negative and 15,8% indeterminate. Factors significantly associated with a positive test are older age, history of active tuberculosis and abnormal chest X-ray. Disease activity significantly influence indeterminate results rate, positively for rheumatoid arthritis, negatively for spondyloarthritis. There is no influence of BCG vaccination or treatment. The concordance rate between T-SPOT.TB®; ; and TST is low (kappa =0,17). In conclusion, T-SPOT.TB®; ; is well correlated with most of the risk factors of tuberculosis and little influenced by chronic inflammatory arthritis or treatment. However, influence of disease activity on indeterminate results rate could be a problem.
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https://hal.univ-lorraine.fr/hal-01731883
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Félicie Costantino. Diagnostic de tuberculose latente chez des patients atteints de rhumatisme inflammatoire chronique candidats à une biothérapie : facteurs infuençant le résultat d'un test de libération d'interféron gamma (T-SPOT.TB®). Sciences du Vivant [q-bio]. 2010. ⟨hal-01731883⟩

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