TY - JOUR
T1 - High rates of tuberculin skin test positivity due to methotrexate therapy
T2 - False positive results?
AU - Arias-Guillén, Miguel
AU - Sánchez Menéndez, Marta M.
AU - Alperi, Mercedes
AU - Riestra, Sabino
AU - González Budiño, María Teresa
AU - García-Clemente, Marta María
AU - Martínez-González, Susana
AU - Enríquez, Ana Isabel
AU - Alonso-Arias, Rebeca
AU - Palacios Gutiérrez, Juan José
AU - Santibáñez, Miguel
AU - Coto-Segura, Pablo
AU - Camblor, Pablo Martínez
AU - García-Alfonso, Lucía
AU - Morante, Isla
AU - Escalante, Patricio
N1 - Funding Information:
The authors would like to thank Dr. José María García García (Sociedad Española de Neumología y Cirugía Torácica-SEPAR) and Prof. Dr. med. J\xFCrgen Behr (Direktor der Medizinischen Klinik und Poliklinik V. Klinikum der Ludwig-Maximilians-Universit\xE4t M\xFCnchen. CA und \xC4D Asklepios Fachkliniken M\xFCnchen Gauting. Comprehensive Pneumology Center Munich (CPC-M). Mitglied des Deutschen Zentrums f\xFCr Lungenforschung (DZL)) for their critical reading of this manuscript, Portions of the manuscript for this paper were translated by Mary Ellen Kerans, who also edited language or advised on English usage in some drafts.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/12
Y1 - 2018/12
N2 - Rationale: The tuberculin skin test (TST) and interferon ? release assays (IGRAs) are commonly used for latent tuberculosis infection (LTBI) screening. Unexpectedly high TST positivity rates have been reported in patients with rheumatic diseases, and methotrexate is frequently used in this population. We hypothesized that methotrexate use could be associated with false-positive TST results. Objectives: To investigate whether treatment with methotrexate and other factors are associated with false-positive TST results in patients with rheumatic diseases. Methods: Prospective single-center study conducted between April 2013 and March 2016. Adult patients with rheumatic diseases were evaluated with a TST and two IGRAs for LTBI screening. We compared TST and IGRA results in patients treated and not treated with methotrexate and analyzed for factors associated with positive TST results. Conclusions: Our data suggest false-positive TST results associated with methotrexate therapy. Thus, we recommend against using the TST for LTBI screening in patients receiving methotrexate and the preferential use of IGRAs in such patients. Measurements and Main Results: We studied 393 patients with rheumatic diseases, including ankylosing spondylitis (ASP, n = 90), rheumatoid arthritis (RA; n = 120), psoriatic arthritis (PA, n = 126), and other disorders (n = 57). The rate of TST positivity varied across the groups: ASP 22.2%, RA 25%, PA 35.7%, and other disorders (22.8%). Positivity rates were lower with IGRAs. Methotrexate use was associated with a statistically significant two-fold increase in the risk of a positive TST and a dose\x96 response relationship was observed. We found no statistically significant associations between methotrexate use and IGRA test positivity.
AB - Rationale: The tuberculin skin test (TST) and interferon ? release assays (IGRAs) are commonly used for latent tuberculosis infection (LTBI) screening. Unexpectedly high TST positivity rates have been reported in patients with rheumatic diseases, and methotrexate is frequently used in this population. We hypothesized that methotrexate use could be associated with false-positive TST results. Objectives: To investigate whether treatment with methotrexate and other factors are associated with false-positive TST results in patients with rheumatic diseases. Methods: Prospective single-center study conducted between April 2013 and March 2016. Adult patients with rheumatic diseases were evaluated with a TST and two IGRAs for LTBI screening. We compared TST and IGRA results in patients treated and not treated with methotrexate and analyzed for factors associated with positive TST results. Conclusions: Our data suggest false-positive TST results associated with methotrexate therapy. Thus, we recommend against using the TST for LTBI screening in patients receiving methotrexate and the preferential use of IGRAs in such patients. Measurements and Main Results: We studied 393 patients with rheumatic diseases, including ankylosing spondylitis (ASP, n = 90), rheumatoid arthritis (RA; n = 120), psoriatic arthritis (PA, n = 126), and other disorders (n = 57). The rate of TST positivity varied across the groups: ASP 22.2%, RA 25%, PA 35.7%, and other disorders (22.8%). Positivity rates were lower with IGRAs. Methotrexate use was associated with a statistically significant two-fold increase in the risk of a positive TST and a dose\x96 response relationship was observed. We found no statistically significant associations between methotrexate use and IGRA test positivity.
KW - Tuberculin Skin Test
KW - interferon ? release assays
KW - latent tuberculosis infection
KW - methotrexate
KW - rheumatic disease
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U2 - 10.1016/j.semarthrit.2018.03.018
DO - 10.1016/j.semarthrit.2018.03.018
M3 - Article
C2 - 29735171
AN - SCOPUS:85046624272
SN - 0049-0172
VL - 48
SP - 538
EP - 546
JO - Seminars in Arthritis and Rheumatism
JF - Seminars in Arthritis and Rheumatism
IS - 3
ER -