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ENGLISH SUMMARY
Introduction: Treatment with TNFα inhibitors (TNFαi) greatly increases
the risk of reactivation of tuberculosis in rheumatic patients. Therefore,
it is recommended to screen patients for tuberculosis before initiating
TNFαi treatment. Iceland has a low prevalence of tuberculosis and BCG
vaccination is not routine praxis. The purpose of this study was to review
the results from TB-screening in routine praxis and to analyze whether
changes in the screening process are to be recommended.
Material and methods: All patients with RA, PsA and AS who were
registered in ICEBIO (1999-2014) due to TNFαi treatment were included.
Data collection consisted of age, sex, start date of TNFαi treatment and
results from a tuberculin skin test (TST) and chest x-ray. The data were
then crosschecked with the Berkill registry, a nationwide database for
TB.
Results: 756 individuals (58% female, mean-age of 54 years) were
included. TST was negative in 614 cases (81%), 41 positive (5.4%), 9
false positives (1.2%) and 92 were missing (12%). 119 patients were
registered in Berkill whereof 72 had a history of positive TST and 55 had
been vaccinated, while 14 patients had been diagnosed with tuberculo-
sis (where of 7 had negative TST on screening). Three patients were
diagnosed with tuberculosis after the TNFi treatment.
Conclusion: These results illustrate the importance of tuberculosis
screening before initiating TNFαi treatment. Improvement in registration
of TST results is necessary and whether interferon gamma release
assays (IGRA) should be added to the screening process remains to be
discussed.
Screening for tuberculosis before TNFα treatment in routine rheumatic care in Iceland.
Result from the nationwide ICEBIO registry
Þórir Már Björgúlfsson1, Gerður Gröndal1, Þorsteinn Blöndal2, Björn Guðbjörnsson3,4
1Department of rheumatology, University Hospital, Iceland, 2Centre for Communicable Disease Prevention and Control, Iceland, 3Centre for Rheumatology Research,
University Hospital, Iceland, 4The Faculty of Medicine, University of Iceland.
Key words: ankylosing spondylitis, ICEBIO, psoriatic arthritis, rheumatoid arthritis, TNFα inhibitors, tuberculosis.
Correspondence: Þórir Már Björgúlfsson, Thb1@hi.is