title: Screening of tuberculosis by interferon-gamma assay before biologic therapy for rheumatoid arthritis.
abstract: Infection with Mycobacterium tuberculosis (M. tuberculosis) is a critical complication in anti-TNF therapies. In 141 BCG vaccinated healthy individuals and 71 rheumatoid arthritis (RA) patients as screening before anti-TNF therapies, M. tuberculosis specific immune responses were evaluated by tuberculin skin test (TST) and enzyme-linked immunospot assay (ELISPOT), which detected antigen specific IFN-gamma secreting cells in peripheral blood mononuclear cells simulated with either purified protein derivative (PPD), early secretory antigen target 6 (ESAT-6) or culture filtrate protein 10 (CFP-10). Induration over 5 mm in TST was found in 87.9% of controls and 21.4% of RA patients. Erythema size in TST was significantly suppressed in RA patients, especially those receiving prednisolone (PSL), whereas the PPD specific IFN-gamma secretion was less attenuated. Significant responses to either ESAT-6 or CFP-10 in ELISPOT were detected in 14.1% of RA patients including those having positive TST, while the ELISPOT assay was negative in all healthy individuals and 73.3% of RA patients having positive TST. Of ELISPOT positive RA patients, mean dosage of PSL was 4.58 mg and 1.25 mg in TST negative and positive patients, respectively. Thus, ELISPOT is useful for screening of tuberculosis in RA patients, even in those receiving corticosteroids.
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Murakami
authors.forename: Mistuhiro
authors.initials: M
authors.lastname: Takeno
authors.forename: Yohei
authors.initials: Y
authors.lastname: Kirino
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Reikou
authors.initials: R
authors.lastname: Watanabe
authors.forename: Makoto
authors.initials: M
authors.lastname: Kudo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ihata
authors.forename: Atsuhisa
authors.initials: A
authors.lastname: Ueda
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ohno
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watanuki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kaneko
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D001500:BCG Vaccine; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007371:Interferon-gamma / Q000096:biosynthesis* / Q000097:blood; D055985:Latent Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000276:immunology; D014373:Tuberculin / Q000276:immunology; D014374:Tuberculin Test; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D001500:BCG Vaccine; D007166:Immunosuppressive Agents; D014373:Tuberculin; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma