title: How many patients with rheumatic diseases and TNF inhibitors treatment have latent tuberculosis?
abstract: OBJECTIVE
  Spanish clinical guidelines recommend screening patients for tuberculosis (TB) before TNF inhibitors (TNFi) treatment. Our objective was to estimate the prevalence of TST seroconversion as an estimation of the prevalence of latent TB in patients with rheumatic diseases and TNFi treatment that have already been screened for tuberculosis.
  
  
  METHODS
  TST, booster and chest x-ray were performed to patients with rheumatic diseases, TNFi treatment, negative tuberculin skin tests before treatment and that were attending the rheumatology Department of three different hospitals in Barcelona. According to the Spanish Society Rheumatology guidelines, these patients had not received TB prophylaxis treatment.
  
  
  RESULTS
  One hundred and forty patients were included in the study. The tuberculin skin test was positive in 4.28% (n=6) of the patients. 50% of the patients were undergoing TNFi ≤ 2 years, being two of the patients only one year on the TNFi when a positive TST was detected. This shows that a conversion of the TST can occur even few months or years after the TNFi is started.
  
  
  CONCLUSIONS
  The present study observed that 4.28% of patients with rheumatic diseases on TNFi who did not have performed a pre-treatment TB prophylaxis, had a conversion of the TST. Moreover, the conversion of the TST had been within the first two years of treatment in half of the patients of our cohort. In spite of these results, false TST positives in the diagnosis of latent TB cannot be excluded as an explanation for our results.
authors.affiliation: Rheumatology Department, Hospital General de Granollers, Granollers, Spain. Electronic address: nbusquets@fhag.es.
authors.forename: Noemi
authors.initials: N
authors.lastname: Busquets-Pérez
authors.affiliation: Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Ponce
authors.affiliation: Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
authors.forename: Vera
authors.initials: V
authors.lastname: Ortiz-Santamaria
authors.affiliation: Rheumatology Department, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Juanjosé
authors.initials: J
authors.lastname: de Agustín de Oro
authors.affiliation: Rheumatology Department, Hospital Fundación del Esperit Sant de Sta. Coloma de Gramenet, Barcelona, Spain.
authors.forename: Yolanda León
authors.initials: YL
authors.lastname: Hernández-Rico
authors.affiliation: Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
authors.forename: Imma
authors.initials: I
authors.lastname: Vidal
authors.affiliation: Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Alfonso
authors.affiliation: Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Argemí
authors.affiliation: Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Muñoz
authors.affiliation: Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Quispe
authors.affiliation: Rheumatology Department, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Ana Carolina
authors.initials: AC
authors.lastname: Díaz
authors.affiliation: Rheumatology Department, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Campos
authors.affiliation: Rheumatology Department, Hospital Fundación del Esperit Sant de Sta. Coloma de Gramenet, Barcelona, Spain.
authors.forename: Teresa Mariné
authors.initials: TM
authors.lastname: Hernández
authors.affiliation: Rheumatology Department, Hospital Fundación del Esperit Sant de Sta. Coloma de Gramenet, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Torres
authors.affiliation: Rheumatology Department, Hospital General de Granollers, Granollers, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Surís
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012216:Rheumatic Diseases / Q000150:complications* / Q000188:drug therapy; D013030:Spain; D014374:Tuberculin Test; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNF therapy; Enfermedades reumáticas; Rheumatic diseases; Tratamiento anti-TNF; Tuberculosis