POS1436 EPIDEMIOLOGY OF LATENT TUBERCULOSIS INFECTION IN PATIENTS WITH RHEUMATIC IMMUNE-MEDIATED DISEASES. SINGLE UNIVERSITY STUDY OF 1117 PATIENTS
Authors: D. Martínez-López, J. Osorio-Chavez, C. Álvarez-Reguera, V. Portilla, M. A. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2021)

Background: Patients with rheumatologic immune-mediated diseases (R-IMID) with Latent tuberculosis infection (LTBI) requiring biologic therapy (BT) are at an increased risk of active tuberculosis (TB). Screening of LTBI with tuberculin skin test (TST) and/or Interferon (IFN)-γ release assays (IGRA) is recommended before starting of BT. Objectives: In patients with R-IMID previously to BT our aim was to assess a ) prevalence of LTBI, b ) importance of using a booster test in negative TST and c ) to compare TST with the IGRA test. Methods: Cross-sectional single University Hospital study including all patients diagnosed with R-IMID who underwent a TST and/or IGRA in the last five years (2016-2020). TST was performed by a subcutaneous injection of 0.1 ml of purified protein derivative (PPD) with a reading after 72 hours. TST was considered positive with an induration of more than 5 mm of diameter. If the first TST was negative, a new TST (Booster) was performed between 1 and 2 weeks after the first TST. LTBI was diagnosed by a positive IGRA and/or TST and absence of active TB (Chest radiograph). Diagnosis with IGRA vs TST was compared (Cohen’s kappa coefficient). Results: We included 1117 patients (741 women/376 men), mean age 53±15 years with LTBI. Chest radiograph was normal in most of the patients, only 39 patients (3.5%) presented signs of previous TB infection, mostly granuloma. Total LTBI prevalence was 31.7% (354/1117). LTBI prevalence in different underlying R-IMID ranges from 35% in vasculitis up to 26.5% in conectivopathies (Figure 1 ). Booster was positive in 66 patients (7.7%) out of 859 patients with a negative simple TST. Results of TST (+booster) and IGRA tests are shown in Table 1. TST (+booster) was positive in 187 patients (22.9%) out of 817 with a negative or indeterminate IGRA test. IGRA test was positive in 30 (3.8%) out of 793 patients with a negative TST (+booster). Cohen’s Kappa coefficient between TST (+booster) and IGRA (QFT-plus), was 0.381. Conclusion: LTBI is frequent between patients with R-IMID. Booster after negative simple TST may be useful, since it can detect false negatives for LTBI. IGRA and TST(+booster) show a low grade of agreement. Therefore, performing both tests before BT may be recommendable. Table 1. Results of TST (+booster) and IGRA test IGRA (QFT-Plus ) Positive Negative Indeterminate Unavailable Total TST (+Booster ) Positive 89 142 45 48 324 Negative 30 500 130 133 793 Total 119 642 175 181 1117 * Cohen’s kappa coefficient: 0.381 Figure 1. Prevalence of LTBI in different underlying R-IMID LTBI: Latent tuberculosis infection, PsA: Psoriatic arthritis, RA: Rheumatoid arthritis, SpA: Axial spondyloarthritis. Diagnosis of LTBI: Positive TST(+booster) and/or IGRA test. Disclosure of Interests: David Martínez-López: None declared, Joy Osorio-Chavez: None declared, Carmen Álvarez-Reguera: None declared, Virginia Portilla: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi and MSD, Consultant of: Abbvie, Pfizer, Roche, Sanofi and MSD, Grant/research support from: Abbvie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD, Grant/research support from: Abbvie, MSD, and Roche