title: Patients with psoriasis are more likely to be treated for latent tuberculosis infection prior to biologics than patients with inflammatory bowel disease.
abstract: Screening for latent tuberculosis infection (LTBI) is recommended before treatment with biologics is initiated in patients with psoriasis or inflammatory bowel disease (IBD). Our objective was to evaluate the effect of underlying disease (psoriasis or IBD) on the risk of LTBI diagnosis prior to anti-tumor necrosis factor-alpha (TNF-α) therapy. During a two-year period LTBI diagnosis rate was compared in consecutive patients with psoriasis or IBD (Crohn's disease or ulcerative colitis). IBD patients (n = 33) had significantly smaller tuberculin skin testing compared to psoriasis patients (n = 30) (p = 0.007). Applying LTBI diagnosis guidelines resulted in more psoriasis (50%) than IBD patients (24.2%) receiving treatment for LTBI prior to onset of anti-TNF-α treatment (p = 0.04). In conclusion, current recommendations for LTBI diagnosis must be re-evaluated to account for the unique tuberculin hyperactive state of the skin of patients with psoriasis.
authors.affiliation: Department of Skin and Venereal Diseases, University of Ioannina Medical School, University Campus, Ioannina, Greece. ibassuka@cc.uoi.gr
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Bassukas
authors.forename: Maria
authors.initials: M
authors.lastname: Kosmidou
authors.forename: Georgios
authors.initials: G
authors.lastname: Gaitanis
authors.forename: Georgia
authors.initials: G
authors.lastname: Tsiouri
authors.forename: Epameinondas
authors.initials: E
authors.lastname: Tsianos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000995:Antitubercular Agents / Q000008:administration & dosage*; D001688:Biological Products / Q000008:administration & dosage*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D003424:Crohn Disease / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D004334:Drug Administration Schedule; D005189:False Positive Reactions; D005260:Female; D006115:Greece; D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011565:Psoriasis / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014374:Tuberculin Test; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha