Biyolojik ajan kullanan çocukluk çağı romatizma hastalarının latent tüberküloz enfeksiyonu açısından tüberkülin deri testi ve interferon gama salınım testleri ile değerlendirilmesi
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Çalışmanın amacı, romatolojik hastalıklar nedeniyle biyolojik ajan tedavisi başlanan olgularda Tüberkülin Deri Testi (TDT) ve QuantiFERON-TB Gold In-Tube (QFT-GIT) testlerinin Latent Tüberküloz Enfeksiyonu (LTBE) tanısı koymadaki etkinliğinin değerlendirilmesidir. GEREÇ ve YÖNTEM: Çalışmamızda Ege Üniversitesi Çocuk Romatoloji Bilim Dalı Polikliniğinde takip edilen Ocak 2011–Mart 2021 tarihleri arasında biyolojik ajan tedavisi başlanmış 106 olgu dahil edildi. Veriler hastane bilgi kayıt sisteminden ve poliklinik dosyalarından retrospektif olarak taranarak olgu rapor formuna kaydedildi. Demografik veriler, tanı grupları, izlem süresince verilen tedaviler, biyolojik ajan tedavisi başlanmadan önce ve sonrasında yapılan Tüberkülin Deri Testi (TDT) ve QuantiFERON-TB Gold In-Tube (QFT-GIT) sonuçları, başlanan biyolojik ajan tedavileri ve LTBE profilaksi durumu saptanarak analiz edildi. BULGULAR: 106 olgunun 52'si (%49.1) kız, 54'ü (%50.9) erkekti. Ortalama semptom yaşı 8.3 ± 4.9, tanı yaşı 9 ± 4.8,vbiyolojik ajan başlama yaşı 11.1 ± 4.8 idi. Hastalık gruplarının dağılımında en sık 66 (%62.3) olgu ile juvenil idiyopatik artritli (JİA) olgusu saptandı. JİA alt grupları dağılımında en sık 31 (%29.2) olgu ile oligoartiküler ardından da 15 (%14.2) olgu ile sistemik JİA saptandı. Olgularda kullanılan toplam 144 biyolojik ajanın 47'si (%32.6) adalimumab, 44'ü (%30.5) etanersept, 22'si (%15.3) tosilizumab, 16'sı (%11.1) kanakinumab, 8'i (%5) anakinra, 5'i (%3.4) infliksimab ve 2'si (%1.4) rituximab olarak saptandı. Tedavide ilk başlanan ajanlar değerlendirildiğinde ise en sık etanersept (%37.7), ikinci sıklıkla adalimumab (%28.3) bulundu. Ortalama biyolojik ajan kullanım süresi 19.3 ± 15.6 ay olarak belirlendi. Biyolojik ajan başlanmadan önce TDT uygulanan 104 olgudan 30'unda (%28.8) sonuç pozitif TDT (≥ 5 mm), QFT-GIT uygulanan 98 olgudan 9'unda (%9.2) test pozitif olarak saptandı. Eş zamanlı tetkikleri yapılanlar değerlendirildiğinde her 2 test pozitif olan 5 (%5.2), TDT pozitif QFT-GIT negatif 19 (%19.8), TDT negatif QFT-GIT pozitif 3 (%3.1) olgu saptandı. Toplam 31 (%29.2) olguya LTBE nedeni ile izoniazid profilaksisi verildi ve 19'u (%61.3) biyolojik ajan tedavi başlanmadan INH profilaksisi aldı. LTBE enfeksiyonu saptanan olgulara INH başlanarak 1 ay biyolojik ajan tedavileri geciktirdi ve INH profilaksisi 9 aya tamamlandı. Çalışmamızda hiçbir olgu aktif tüberküloz enfeksiyonu tanısı almamıştır. SONUÇ: Klasik tedavi yöntemleri ile yanıt alınamayan romatolojik hastalıklarda biyolojik ajanların hastalık aktivasyonunu durdurarak etkili ve anlamlı yan etki izlenmemesi, aktif Tüberküloza yol açmaması nedeniyle güvenli olduğu görülmüştür. Biyolojik ajanların en önemli komplikasyonlarından biri LTBE'ye eğilim oluşturmasıdır, bu nedenle olgular ajan başlanmadan önce ve ajan başlandıktan sonraki dönemde TDT ve QFT-GIT tetkikleri ile aralıklı olarak taranmalıdırlar.
AIM: The main aim of this study was to investigate the diagnostic effectiveness of tuberculin skin test (TST) and QantiFERON-TB Gold In-Tube (QFT-GIT) in cases whom biological agent therapy was initiated due to rheumatological diseases. MATERIALS AND METHOD: In this study, we included 106 cases followed up by Ege University Pediatric Rheumatology Department between January 2011 and March 2021 who received biological agent therapy for their treatment-resistant rheumatological diseases. Demographic data, diagnosis, treatments during the follow-up period, TST and QFT-GIT results before and after biological agent treatment, and latent tuberculosis infection (LTBI) prophylaxis status were evaluated. RESULTS: In our study, 52 (%49.1) of cases are female and 54 (%50.9) are male. Mean symptom age is 8.3±4.9, mean diagnosis age is 9±4.8, and mean biological agent onset age is 11.1±4.8. The most common disease group in this study is juvenile idiopathic arthritis (JIA) with 66 cases (%62.3). Evaluation of JIA subtypes shows that oligoarticular JIA (%29.2) and systemic JIA (%14.2) are the most common JIA subtypes. Totally 144 biological agent was used which of 47 (%32.6) adalimumab, 44 (%30.5) etanercept, 22 (%15.3) tocilizumab, 16 (%11.1) canakinumab, 8 (%5) anakinra, 5 (%3.4) infliximab and 2 (%1.4) rituximab. The most common biological agents used as the first choice were etanercept (%37.7) and adalimumab (%28.3). The mean biological agent treatment time is 19.3 ± 15.6 months. The mean biological agent treatment time was 19.3 ± 15.6 months. Thirty (%28.8) of 104 cases had positive TST (≥ 5 mm) and 9 (%9.2) of 98 cases had positive QFT-GIF test before biological agent therapy was initiated. For the patients whose TST and QFT-GIT tests were done simultaneously, five (%5.2) cases were positive on both tests, 19 (%19.8) cases have TST positive / QFT-GIF negative, 3 (%3.1) cases have TST negative / QFT-GIT positive results. A total of 31 cases (%29.2) were given isoniazid prophylaxis due to LTBI and 19 of these cases (%61.3) were used INH prophylaxis before the onset of biological agent therapy. In cases with LTBI infection, INH was started and biologic agent treatments were delayed for 1 month, INH prophylaxis was completed for 9 months. In our study, none of the cases was diagnosed with active tuberculosis disease. CONCLUSION: Various studies have shown that biological agents are effective in the cessation progression of rheumatological diseases that do not respond to classical therapeutic agents and are safe because they do not cause serious adverse effects or active tuberculosis infection. One of the most important complications of biological agents is a tendency to LTBI and therefore patients should be screened intermittently before and after initiation of therapy by TST and QFT-GIF tests.
AIM: The main aim of this study was to investigate the diagnostic effectiveness of tuberculin skin test (TST) and QantiFERON-TB Gold In-Tube (QFT-GIT) in cases whom biological agent therapy was initiated due to rheumatological diseases. MATERIALS AND METHOD: In this study, we included 106 cases followed up by Ege University Pediatric Rheumatology Department between January 2011 and March 2021 who received biological agent therapy for their treatment-resistant rheumatological diseases. Demographic data, diagnosis, treatments during the follow-up period, TST and QFT-GIT results before and after biological agent treatment, and latent tuberculosis infection (LTBI) prophylaxis status were evaluated. RESULTS: In our study, 52 (%49.1) of cases are female and 54 (%50.9) are male. Mean symptom age is 8.3±4.9, mean diagnosis age is 9±4.8, and mean biological agent onset age is 11.1±4.8. The most common disease group in this study is juvenile idiopathic arthritis (JIA) with 66 cases (%62.3). Evaluation of JIA subtypes shows that oligoarticular JIA (%29.2) and systemic JIA (%14.2) are the most common JIA subtypes. Totally 144 biological agent was used which of 47 (%32.6) adalimumab, 44 (%30.5) etanercept, 22 (%15.3) tocilizumab, 16 (%11.1) canakinumab, 8 (%5) anakinra, 5 (%3.4) infliximab and 2 (%1.4) rituximab. The most common biological agents used as the first choice were etanercept (%37.7) and adalimumab (%28.3). The mean biological agent treatment time is 19.3 ± 15.6 months. The mean biological agent treatment time was 19.3 ± 15.6 months. Thirty (%28.8) of 104 cases had positive TST (≥ 5 mm) and 9 (%9.2) of 98 cases had positive QFT-GIF test before biological agent therapy was initiated. For the patients whose TST and QFT-GIT tests were done simultaneously, five (%5.2) cases were positive on both tests, 19 (%19.8) cases have TST positive / QFT-GIF negative, 3 (%3.1) cases have TST negative / QFT-GIT positive results. A total of 31 cases (%29.2) were given isoniazid prophylaxis due to LTBI and 19 of these cases (%61.3) were used INH prophylaxis before the onset of biological agent therapy. In cases with LTBI infection, INH was started and biologic agent treatments were delayed for 1 month, INH prophylaxis was completed for 9 months. In our study, none of the cases was diagnosed with active tuberculosis disease. CONCLUSION: Various studies have shown that biological agents are effective in the cessation progression of rheumatological diseases that do not respond to classical therapeutic agents and are safe because they do not cause serious adverse effects or active tuberculosis infection. One of the most important complications of biological agents is a tendency to LTBI and therefore patients should be screened intermittently before and after initiation of therapy by TST and QFT-GIF tests.
Açıklama
Anahtar Kelimeler
Latent Tüberküloz Enfeksiyonu, Tüberkülin Deri Testi, İnterferon Gama Salınım Testleri, Biyolojik Ajan, Latent Tuberculosis Infection, Tuberculin Skin Test, Interferon Gama Release Assay, Biological Agents
