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Anti-Nuclear Antibody Screening Using HEp-2 Cells

Anti-Nuclear Antibody Screening Using HEp-2 Cells

Published on: June 23, 2014

Coccidioides Serologic Screening Practices in Individuals With Rheumatic and Autoimmune Diseases.

Debbie L Wilson¹, Shubha Kollampare², C Kent Kwoh³

¹University of Florida, Gainesville.

ACR Open Rheumatology

|March 13, 2024

Summary

This summary is machine-generated.

Coccidioides screening rates were low for Medicare patients starting immunosuppressants in endemic areas. Improved adherence to screening guidelines is needed for patients on biologic disease-modifying antirheumatic drugs (b/tsDMARDs).

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Area of Science:

Rheumatology
Infectious Diseases
Public Health

Background:

Coccidioides spp. infections pose a risk to immunocompromised patients.
Biologic disease-modifying antirheumatic drugs (b/tsDMARDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and corticosteroids increase infection risk.
Pre-treatment screening for Coccidioides is recommended in endemic areas.

Purpose of the Study:

To estimate Coccidioides serologic screening rates before initiating b/tsDMARDs, csDMARDs, and/or noninhaled corticosteroids.
To assess screening practices among Medicare beneficiaries in Coccidioides-endemic regions of the US.

Main Methods:

Retrospective cohort study using 2011-2016 US Medicare claims data.
Included beneficiaries with rheumatic/autoimmune diseases in Arizona, California, and Texas.
Estimated prior-year serologic screening incidence before initiating b/tsDMARDs, csDMARDs, or noninhaled corticosteroids.

Main Results:

In Arizona (2012-2016), screening rates were 20.1% before b/tsDMARDs, 8.1% before csDMARDs, and 6.9% before corticosteroids.
Screening rates were significantly lower in California (e.g., 2.8% for b/tsDMARDs) and undetected in Texas.
Adjusted screening rates for b/tsDMARDs in Arizona increased from 14.5% in 2012 to 26.7% in 2016.

Conclusions:

Coccidioides serologic screening rates were low among Medicare beneficiaries on immunosuppressants in endemic regions (2012-2016).
Significant geographic disparities in screening rates were observed.
Alignment between screening recommendations and clinical practice is necessary.