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Prevalence of positive ppd in a cohort of rheumatoid arthritis patients
Maria Natalia Tamborenea1, Guillermo Tate, Eduardo Mysler
1Department of Rheumatology, Organización Médica de Investigación, Uruguay, 725 PB, C1015ABO, Ciudad Autónoma de Buenos Aires, Argentina. nataliatamborenea@hotmail.com
Abstract:
The main objective of this study is to determine the prevalence of positive and anergic tuberculin skin test (ppd) in a rheumatoid arthritis cohort of patients (RA) and assess the association among ppd results and clinical and treatment variables. Patients with RA diagnosis were included. The ppd was done by Mantoux method. Positive result was considered when indurations were equal or greater than 5 mm. Anergic reaction was defined when the indurations was 0 mm. We included 105 patients (N = 105). The prevalence of positive ppd was 12.4% (n = 13), while the 87.6% (n = 92) presented a negative result. The 69.5% (n = 73) of the population were anergic to ppd. Patients with negative result received higher steroids dosages than patients with positive ppd (p < 0.04). In the multivariable model, the steroids dosage was a significant and independent predictor of negative ppd (p = 0.021, OR 0.72, 95% CI 0.55-0.95). Anergic and non-anergic patients were separated in groups, and a new analysis was done. The higher dosage of methotrexate was associated to tuberculine anergy (p = 0.025). In the multivariable model, the methotrexate dosage was a significant and independent predictor of tuberculine anergy (p = 0.005, OR 1.14, 95% CIs 1.04-1.24). In conclusion, in our cohort, the prevalence of positive ppd was lower than others studies. Among analyzed variables, the high steroid dose was a significant and independent predictor of negative ppd. The methotrexate treatment and dose were associated with ppd anergy.
Insights
In rheumatoid arthritis patients, high-dose steroids predicted negative tuberculin skin tests (TST), while methotrexate use correlated with TST anergy. This study investigated TST prevalence and its associations in RA patients.
Area of Science:
- Immunology
- Rheumatology
- Infectious Disease Epidemiology
Background:
- Rheumatoid arthritis (RA) patients often have altered immune responses.
- Tuberculin skin test (TST) is used to screen for latent tuberculosis infection (LTBI).
- Factors influencing TST results in RA patients require further investigation.
Purpose of the Study:
- To determine the prevalence of positive and anergic TST reactions in a cohort of RA patients.
- To assess the association between TST results and clinical/treatment variables in RA.
- To identify predictors of TST positivity, negativity, and anergy in RA.
Main Methods:
- A cohort of 105 RA patients underwent TST using the Mantoux method.
- Positive TST was defined as induration ≥5 mm; anergy was defined as 0 mm induration.
- Statistical analysis, including multivariable modeling, was used to assess associations.
Main Results:
- The prevalence of positive TST was 12.4%, negative TST was 87.6%, and TST anergy was 69.5%.
- Higher steroid dosages were independently associated with negative TST results (OR 0.72).
- Higher methotrexate dosages were independently associated with TST anergy (OR 1.14).
Conclusions:
- The prevalence of positive TST in this RA cohort was relatively low.
- High-dose corticosteroids are a significant predictor of negative TST in RA patients.
- Methotrexate treatment is associated with TST anergy in RA patients, suggesting an impact on cellular immunity.
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