Dhanoop Abraham Varghese, (2020) Prevalence of latent tuberculosis in patients with rheumatoid arthritis and ankylosing spondylitis. Masters thesis, Christian Medical College, Vellore.
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Abstract
BACKGROUND AND AIM OF THE STUDY: Tuberculosis (TB) is one of the most common infectious killers. The incidence of TB in India is as high as 27 lakhs as per 2019 Global TB Report despite the strict medical measures followed towards the effort to control it. Latent tuberculosis is when the patients is infected with mycobacterium tuberculi but have no evidence of active TB. These patients have no symptoms or clinical features suggestive of active tuberculosis. The patients with rheumatologic diseases who are harboring LTBI the risk to develop active tuberculosis is up to 4-fold compared with the general population. It was also noted that the risk of reactivation of latent tuberculosis infection was 2% - 30% per life year in patients on biological therapy for treatment of underlying rheumatologic diseases (1). Our study will help in finding out the burden of latent tuberculosis in patients with Rheumatoid arthritis and Ankylosing spondylitis. If the prevalence in the study population is found to be more than the prevalence of LTBI in general population, more strict screening can be ensured which will reflect in controlling the seedbed of TB. METHODS: Our study is a Cross sectional study of consecutive patients with Rheumatoid arthritis and Ankylosing spondylitis who are treatment naïve with regards to steroids, immune suppressants and biological drugs attending Rheumatology and Pulmonary Medicine OPD. The enrollees were screened for active TB with AFB smear (if symptomatic) and Chest X ray and excluded from the study if active TB is detected and appropriate treatment will be initiated. Those who enrolled into the study were tested for LTBI with QuantiFERON GOLD (QFT) and TST. The results of TST was read after 48-72 hours of administration of the PPD RESULTS: From our study we inferred that the prevalence of latent tuberculosis infection in patients with rheumatoid arthritis and ankylosing spondylitis was 60.11 (95% Confidence interval (CI), 52.52- 67.36). This was estimated by an overall positive test results by TST and QFT. Prevalence of LTBI by TST only was 51.12 (95% Confidence interval (CI), 43.53- 58.67%) and prevalence of LTBI by QFT only was 47.75 (95% Confidence interval (CI), 40.23-55.35%). The Prevalence of LTBI in RA was 58.1 % (95% CI 49.7 – 66.1), this was from 86 LTBI positive from 148 patients with RA. Similarly the prevalence of LTBI in AS was 70% (95% CI 50.6 – 85.2%)), this was from 21 LTBI positive from 30 patients with AS. CONCLUSION: From this study we conclude that the prevalence of latent tuberculosis among the risk population with rheumatologic diseases like rheumatoid arthritis and ankylosing spondylitis is 60.11 (95% CI, 52.52- 67.36) which is much higher than the data among general population as 40%. In the absence of a gold standard test to diagnose latent tuberculosis infection we would recommend initial testing by tuberculin skin test and if found negative to test with IGRA to avoid not diagnosing LTBI which have potential to reactivate to active TB disease in this population.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 201727203 |
| Uncontrolled Keywords: | Prevalence, latent tuberculosis, rheumatoid arthritis, ankylosing spondylitis. |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 04 Feb 2021 16:41 |
| Last Modified: | 04 Feb 2021 16:41 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13816 |
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