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Skimun fyrir berklum meðal gigtarsjúklinga sem hófu meðferð með TNFa-hemlum á Íslandi 1999-2014

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Authors
Þórir Björgúlfsson
Gerður Gröndal
Þorsteinn Blöndal
Björn Guðbjörnsson
Issue Date
2018-05-03

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Other Titles
Screening for tuberculosis before TNFα treatment in routine rheumatic care in Iceland. Result from the nationwide ICEBIO registry
Citation
Skimun fyrir berklum meðal gigtarsjúklinga sem hófu meðferð með TNFa-hemlum á Íslandi 1999-2014. 2018 104(5):231-235 Læknablaðið
Abstract
Inngangur: Sjúklingar með liðbólgusjúkdóma sem fá líftæknilyfjameðferð eiga aukna hættu á endurvakningu dulinna berkla. Því ráðleggja klínískar leiðbeiningar berklaskimun áður en meðferð með TNFα-hemlum hefst. Hérlendis er berklasmit sjaldgæft og almennt ekki BCG-bólusett. Meginmarkmið þessarar rannsóknar var að fá yfirlit yfir berklaskimun þessa sjúklingahóps og kanna hvort breyta þurfi verkferlum. Efniviður og aðferðir: Gögn allra sjúklinga með iktsýki, hrygggikt eða sóragigt, sem skráðir voru í ICEBIO (1999-2014) vegna fyrirhugaðrar meðferðar með TNFα-hemli voru skoðuð með tilliti til aldurs, kyns og húðprófs fyrir berklum (TST). Niðurstaða lungnamyndar var einnig skráð sem og hvenær TNFα-hemla meðferðin hófst. Þá voru niðurstöðurnar samkeyrðar við upplýsingar í Berkli, sem er landsskrá um berklasmit á Íslandi. Niðurstöður: Alls voru skráðir 756 einstaklingar (meðalaldur 54 ár, 58% konur) í ICEBIO. Húðpróf (TST) reyndist neikvætt hjá 614 einstaklingum (81%), 41 höfðu jákvætt TST-próf (5,4%), 9 voru með falskt jákvætt húðpróf (1,2%), ekki var unnt að finna niðurstöður á TST frá 92 einstaklingum (12%). Í Berkli reyndust 119 þessara 756 einstaklinga einnig vera skráðir; 72 með sögu um jákvætt húðpróf og 55 höfðu fengið bólusetningu, á meðan 14 sjúklingar höfðu verið greindir með berkla (þar af voru 7 með neikvætt TST við skimun). Þrír sjúklingar voru greindir með berklasýkingu eftir að TNFα-hemla meðferðin hófst. Ályktun: Niðurstöður þessar endurspegla mikilvægi berklaskimunar áður en meðferð með TNFα-hemlum er hafin. Mikilvægt er að skrá betur niðurstöður húðprófa við skimun og íhuga má í völdum tilfellum að framkvæma ítarlegri berklaskimun með IGRA.
Introduction: Treatment with TNFα inhibitors (TNFαi) greatly increases the risk of reactivation of tuberculosis in rheumatic patients. Therefore, it is recommended to screen patients for tuberculosis before initiating TNFαi treatment. Iceland has a low prevalence of tuberculosis and BCG vaccination is not routine praxis. The purpose of this study was to review the results from TB-screening in routine praxis and to analyze whether changes in the screening process are to be recommended. Material and methods: All patients with RA, PsA and AS who were registered in ICEBIO (1999-2014) due to TNFαi treatment were included. Data collection consisted of age, sex, start date of TNFαi treatment and results from a tuberculin skin test (TST) and chest x-ray. The data were then crosschecked with the Berkill registry, a nationwide database for TB. Results: 756 individuals (58% female, mean-age of 54 years) were included. TST was negative in 614 cases (81%), 41 positive (5.4%), 9 false positives (1.2%) and 92 were missing (12%). 119 patients were registered in Berkill whereof 72 had a history of positive TST and 55 had been vaccinated, while 14 patients had been diagnosed with tuberculo­sis (where of 7 had negative TST on screening). Three patients were diagnosed with tuberculosis after the TNFi treatment. Conclusion: These results illustrate the importance of tuberculosis screening before initiating TNFαi treatment. Improvement in registration of TST results is necessary and whether interferon gamma release assays (IGRA) should be added to the screening process remains to be discussed.
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http://laeknabladid.is/tolublod/2018/05/nr/6721
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ae974a485f413a2113503eed53cd6c53
10.17992/lbl.2018.05.184
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Icelandic Journal Articles (Peer Reviewed)

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