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High rates of tuberculin skin test positivity due to methotrexate therapy: False positive results?

dc.contributor.authorArias-Guillén M.
dc.contributor.authorSánchez Menéndez M.M.
dc.contributor.authorAlperi M.
dc.contributor.authorRiestra S.
dc.contributor.authorGonzález Budiño M.T.
dc.contributor.authorGarcía-Clemente M.M.
dc.contributor.authorMartínez-González S.
dc.contributor.authorEnríquez A.I.
dc.contributor.authorAlonso-Arias R.
dc.contributor.authorPalacios Gutiérrez J.J.
dc.contributor.authorSantibáñez M.
dc.contributor.authorCoto-Segura P.
dc.contributor.authorCamblor P.M.
dc.contributor.authorGarcía-Alfonso L.
dc.contributor.authorMorante I.
dc.contributor.authorEscalante P.
dc.date.accessioned2020-09-02T22:12:27Z
dc.date.available2020-09-02T22:12:27Z
dc.date.issued2018
dc.identifier10.1016/j.semarthrit.2018.03.018
dc.identifier.citation48, 3, 538-546
dc.identifier.issn00490172
dc.identifier.urihttps://hdl.handle.net/20.500.12728/3612
dc.descriptionRationale: The tuberculin skin test (TST) and interferon ? release assays (IGRAs) are commonly used for latent tuberculosis infection (LTBI) screening. Unexpectedly high TST positivity rates have been reported in patients with rheumatic diseases, and methotrexate is frequently used in this population. We hypothesized that methotrexate use could be associated with false-positive TST results. Objectives: To investigate whether treatment with methotrexate and other factors are associated with false-positive TST results in patients with rheumatic diseases. Methods: Prospective single-center study conducted between April 2013 and March 2016. Adult patients with rheumatic diseases were evaluated with a TST and two IGRAs for LTBI screening. We compared TST and IGRA results in patients treated and not treated with methotrexate and analyzed for factors associated with positive TST results. Conclusions: Our data suggest false-positive TST results associated with methotrexate therapy. Thus, we recommend against using the TST for LTBI screening in patients receiving methotrexate and the preferential use of IGRAs in such patients. Measurements and Main Results: We studied 393 patients with rheumatic diseases, including ankylosing spondylitis (ASP, n = 90), rheumatoid arthritis (RA; n = 120), psoriatic arthritis (PA, n = 126), and other disorders (n = 57). The rate of TST positivity varied across the groups: ASP 22.2%, RA 25%, PA 35.7%, and other disorders (22.8%). Positivity rates were lower with IGRAs. Methotrexate use was associated with a statistically significant two-fold increase in the risk of a positive TST and a dose\x96 response relationship was observed. We found no statistically significant associations between methotrexate use and IGRA test positivity. © 2018 Elsevier Inc.
dc.language.isoen
dc.publisherW.B. Saunders
dc.subjectinterferon ? release assays
dc.subjectlatent tuberculosis infection
dc.subjectmethotrexate
dc.subjectrheumatic disease
dc.subjectTuberculin Skin Test
dc.subjectbiological product
dc.subjectcorticosteroid derivative
dc.subjectdisease modifying antirheumatic drug
dc.subjectleflunomide
dc.subjectmethotrexate
dc.subjectmethotrexate
dc.subjectadult
dc.subjectaged
dc.subjectankylosing spondylitis
dc.subjectArticle
dc.subjectcohort analysis
dc.subjectcontrolled study
dc.subjectdose response
dc.subjectfalse positive result
dc.subjectfemale
dc.subjecthuman
dc.subjectinterferon gamma release assay
dc.subjectintermethod comparison
dc.subjectlatent tuberculosis
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectpriority journal
dc.subjectprospective study
dc.subjectpsoriatic arthritis
dc.subjectrheumatic disease
dc.subjectrheumatoid arthritis
dc.subjectrisk assessment
dc.subjectscreening test
dc.subjecttuberculin test
dc.subjectfalse positive result
dc.subjectlatent tuberculosis
dc.subjectmiddle aged
dc.subjecttuberculin test
dc.subjectAdult
dc.subjectFalse Positive Reactions
dc.subjectFemale
dc.subjectHumans
dc.subjectLatent Tuberculosis
dc.subjectMale
dc.subjectMethotrexate
dc.subjectMiddle Aged
dc.subjectProspective Studies
dc.subjectRheumatic Diseases
dc.subjectTuberculin Test
dc.titleHigh rates of tuberculin skin test positivity due to methotrexate therapy: False positive results?
dc.typeArticle


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