title: An evaluation of the tuberculin skin test for anti TNF alpha prophylaxis in patients with ankylosing spondylitis and rheumatoid arthritis.
abstract: OBJECTIVE
  The tuberculin skin test (TST) has recently been proposed as a screening procedure for latent TB prior to anti-tumor necrosis factor (TNF) alpha therapy. Our aim was to evaluate TST levels in patients receiving anti TNF alpha due to ankylosing spondylitis (AS) and rheumatoid arthritis (RA).
  
  
  METHODS
  73 AS patients (52 male, 21 female) and 33 RA patients (11 male, 22 female) were enrolled in the study. Patients' clinical and demographic characteristics were recorded. Average age +/- standard deviation was 38.8 +/- 7.2 years for AS and 40.7 +/- 13 for RA. Median number of immunosuppressive agents used was 1 (min-max) (0-2) in AS and 2 (2-3) in RA. To determine the activity of the disease, BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) was measured in AS patients, and DAS 28 (Disease Activity Index) was used in RA patients. TST was performed using the Mantoux method in all patients.
  
  
  RESULTS
  Mean BASDAI was 5.1 +/- 0.8 in AS, and DAS 28 score in RA was 5.7 +/- 0.5. Both, AS and RA patients had active disease. TST values were higher in AS than in RA patients. TST values were 11.5 +/- 6.5 mm in AS patients, compared to 7.0 +/- 6.4 mm in RA patients. A positive correlation between disease duration and TST was determined in AS patients. There was also a weak correlation in RA patients between immunosuppressive use and TST (r = 0.37, p = 0.032). No correlation was determined with disease activation in AS or RA patients.
  
  
  CONCLUSIONS
  This is the first study to evaluate the correlation between the use of multiple immunosuppressive agents and TST. We determined that TST is correlated with disease duration in AS and with the use of multiple immunosuppressive agents in RA (Tab. 3, Ref. 21).
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical Faculty, Karadeniz Technical University, Turkey. muratkarkucak@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Karkucak
authors.forename: E
authors.initials: E
authors.lastname: Capkin
authors.forename: S
authors.initials: S
authors.lastname: Ozsu
authors.forename: I
authors.initials: I
authors.lastname: Nuhoglu
authors.forename: M
authors.initials: M
authors.lastname: Erol
authors.forename: G
authors.initials: G
authors.lastname: Yilmaz
authors.forename: F
authors.initials: F
authors.lastname: Gokmen
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D055985:Latent Tuberculosis / Q000175:diagnosis*; D008297:Male; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000276:immunology; D014374:Tuberculin Test; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha