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Infliximab Does Not Suppress the Tuberculin Skin Test (Purified Protein Derivative)
GULEN HATEMI, MELIKE MELIKOGLU, IZZET FRESKO, SEVAL MASATLIOGLU, KORAY TASCILAR, and HASAN YAZICI ABSTRACT. Objective. Tuberculin skin testing with purified protein derivative (PPD) is part of tuberculosis (TB) screening in patients receiving infliximab. We assessed whether infliximab, a strong inhibitor of inflammation, suppressed dermal induration, the outcome of this test. We also reassessed the booster phenomenon and the interobserver variability in tuberculin testing. Methods. Forty-seven patients with various diagnoses, who had had a PPD test before infliximab use, were retested after infliximab treatment. The test was also assessed cross-sectionally among 31 patients with rheumatoid arthritis (RA) after 8.6 [± 4.1 standard deviation (SD)] months of infliximab use and in 82 patients with RA who had never used this agent. Booster phenomenon and the interobserver variability of reading the test were reassessed among 163 infliximab-naive patients with RA and Behçet's disease (BD) and 47 healthy controls. Results. Among the 47 patients who received infliximab, and for whom sequential data were available, the mean skin induration was 5.9 ± 8.0 SD mm before and 6.1 ± 7.5 mm after 4.8 ± 3.7 months of treatment (p = 0.890). In the cross-sectional study the mean PPD induration was 7.8 ± 8.4 mm among infliximab-naive patients with RA, while it was 6.6 ± 2.1 mm in those receiving infliximab (p = 0.271). Booster phenomenon was observed in 14/49 (29%) of patients with RA, 7/31 (23%) of those with BD, and 1/10 of healthy controls. Interobserver variability of PPD reading was good (kappa = 0.92). Conclusion. Infliximab use does not suppress the skin reaction to tuberculin. We confirm the booster phenomenon and that the PPD skin test has an acceptable interobserver reliability for an in vivo test. (First Release Feb 1 2007; J Rheumatol 2007; 34:474–80) Key Indexing Terms:
TUBERCULOSIS From Istanbul University, Cerrahpasa Medical School, Department of Internal Medicine, Rheumatology Division and Haydarpasa Numune Hospital, Department of Internal Medicine, Istanbul, Turkey. G. Hatemi, MD, Fellow of Rheumatology; M. Melikoglu, MD, Associate Professor of Rheumatology; I. Fresko, MD, Professor of Rheumatology; K. Tascilar, MD, Fellow of Rheumatology; H. Yazici, MD, Professor of Rheumatology, Istanbul University, Cerrahpasa Medical School, Department of Internal Medicine, Rheumatology Division; S. Masatlioglu, MD, Fellow of Rheumatology, Haydarpasa Numune Hospital, Department of Internal Medicine. Address reprint requests to Prof. H. Yazici, Cerrahpasa Tip Fakultesi, Ic Hastaliklari ABD, 34300 Aksaray, Istanbul, Turkey. E-mail: hyazici@attglobal.net Accepted for publication November 9, 2006.
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