1986 The Journal of Rheumatology 2013; 40:12; doi:10.3899/jrheum.130303 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2013. All rights reserved. Screening for Latent Tuberculosis Infection in Patients with Chronic Inflammatory Arthritis: Discrepancies Between Tuberculin Skin Test and Interferon-γ Release Assay Results Félicie Costantino, Marcelo de Carvalho Bittencourt, Anne-Christine Rat, Damien Loeuille, Hervé Dintinger, Marie C. Béné, Gilbert Faure, and Isabelle Chary-Valckenaere ABSTRACT. Objective. Screening for latent tuberculosis infection (LTBI) is mandatory before initiating biologics in patients with chronic inflammatory arthritis (CIA). However, few studies have evaluated the discrepancies between the results of tuberculin skin test (TST) and interferon-γ release assays (IGRA) in these patients. The purpose of our study was to investigate factors associated with TST and IGRA results in a large cohort of patients with CIA before the introduction of biologics. Methods. A total of 563 consecutive patients with CIA (293 rheumatoid arthritis, 270 spondy- loarthritis) and eligible for biologics were prospectively enrolled. Demographic, clinical, and biological data were recorded. Risk factors for LTBI were assessed. All patients underwent a TST, a chest radiograph, and an IGRA test (T-SPOT.TB). Results. Agreement between the 2 tests was low (κ = 0.16). The bacillus Calmette-Guerin (BCG) status was significantly associated with discordance between the 2 tests (p = 0.004). The TST positivity rate was 34.8%. Factors associated with a negative TST were female sex (p = 0.02) and immunosuppressive treatment (p = 0.003). The only LTBI risk factor associated with TST positivity was an abnormal chest radiograph (p = 0.02). T-SPOT.TB was positive in 21.7% of patients and indeterminate in 15.6%. Previous active TB and chest radiograph abnormalities were associated with IGRA positivity (p = 0.008 and p = 3.9 × 10 -5 , respectively). The BCG vaccination was associated with negative IGRA (p = 3 × 10 -4 ). Indeterminate IGRA results were associated with age, C-reactive protein, and immunosuppressive treatment (p = 0.005, 0.007, and 0.004, respectively). Conclusion. Our data support the combined use of T-SPOT.TB and TST in patients with CIA before biologics introduction. However, despite these good diagnostic values, indeterminate results may complicate the use of IGRA. (First Release Oct 1 2013; J Rheumatol 2013;40:1986–93; doi:10.3899/ jrheum.130303) Key Indexing Terms: TUBERCULOSIS BIOLOGICAL AGENTS INTERFERON-γ RELEASE TESTS ANKYLOSING SPONDYLITIS RHEUMATOID ARTHRITIS From the Rheumatology Department and the Immunology Department, CHU Nancy, Nancy; Université de Lorraine, Lorraine, France. F. Costantino, MD, Rheumatology Department, CHU Nancy; M. de Carvalho Bittencourt, MD, PhD, Immunology Department, CHU Nancy, and EA RHEM4369, Université de Lorraine; A.C. Rat, MD, PhD, Rheumatology Department, and INSERM, CIC-EC CIE6, Epidémiologie et Evaluation Cliniques, CHU Nancy; D. Loeuille, MD, PhD, Rheumatology Department, CHU Nancy, and UMR 7365 (IMoPA) CNRS, Université de Lorraine; H. Dintinger, MD, Rheumatology Department, CHU Nancy; M.C. Béné, MD, PhD, Immunology Department, CHU Nancy and EA RHEM4369, Université de Lorraine; G.C. Faure, MD, PhD, Immunology Department, CHU Nancy; EA RHEM4369, Université de Lorraine; I. Chary-Valckenaere, MD, PhD, Rheumatology Department, CHU Nancy, and UMR 7365 (IMoPA) CNRS, Université de Lorraine. Address correspondence to Dr. F. Costantino, Institut Cochin Bâtiment Hardy A, 1e étage, 27 rue du Faubourg Saint Jacques, 75014 Paris, France. E-mail: felicie.costantino@inserm.fr Accepted for publication July 25, 2013. Tumor necrosis factor (TNF) antagonists are very effective treatments of many immune-mediated inflammatory diseases including rheumatoid arthritis (RA) and spondy- loarthritis (SpA). However, anti-TNF therapy is associated with an increased risk of tuberculosis (TB) 1 most often because of reactivation of a latent infection 2 . Therefore, screening for latent TB infection (LTBI) has become mandatory before the initiation of TNF antagonists. National recommendations for LTBI screening based on medical history, clinical examination, tuberculin skin test (TST), and chest radiograph 3,4,5,6,7 have demonstrated their effectiveness to reduce TB incidence 8 . However, despite recommendations, the incidence of TB in patients treated with anti-TNF therapy still remains higher than in the general population 9,10 . Use of the TST has been questioned. Indeed, TST has well-known limitations: poor specificity owing to cross-reactivity with environmental mycobacteria or bacillus Calmette-Guerin (BCG) 11 , poor sensitivity in www.jrheum.org Downloaded on November 26, 2021 from