Riziko latentnej tuberkulózy u pacientov s reumatoidnou artritídou na Slovensku

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Autoři: J. Malinová ¹; M. Hájková ²; A. Hatalová ³; E. Šteňová ¹
Působiště autorů: Department of Pneumology and Phthiseology, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Bratislava, Slovakia ²; Department of Hematology and Transfusiology, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Bratislava, Slovakia ³; stDepartment of Internal Medicine, Faculty of Medicine, Comenius University in Bratislava and University Hospital Bratislava, Slovakia ¹¹
Vyšlo v časopise: Epidemiol. Mikrobiol. Imunol. 70, 2021, č. 2, s. 83-90
Kategorie: Původní práce

Souhrn

Ciele práce: Cieľom práce bolo zistiť prevalenciu latentnej tuberkulózy (LTBI) u pacientov s reumatoidnou artritídou stredne ťažkého a ťažkého stupňa liečených konvenčnou a anticytokínovou terapiou, identifikovať možné rizikové faktory tuberkulózy (TB) a hodnotiť efektivitu profylaktickej liečby u pozitívne skrínovaných pacientov.

Pacienti a metodika: Observačná retrospektívna štúdia so zaradením pacientov s reumatoidnou artritídou po absolvovaní skríningových vyšetrení na zistenie LTBI (röntgenologické vyšetrenie hrudníka, tuberkulínový kožný test, interferon gamma release assay test – IGRA test).

Výsledky: V skupine 124 pacientov sme zistili u 7,25 % LTBI počas kombinovanej liečby konvenčným syntetickým liečbu modifikujúcim antireumatikom (csDMARD) a kortikoterapiou. U ďalších 21,77 % LTBI bola diagnostikovaná počas biologickej liečby alebo terapie inhibítorom Janusových kináz. Najvyššia incidencia LTBI bola zistená v skupine pacientov liečených inhibítormi tumor nekrotizujúceho faktoru (66,66 % z LTBI pozitívnych pacientov), avšak pozitívne skrínovaní pacienti sa vyskytli aj pri liečbe inými modalitami. Priemerná doba detekcie LTBI pozitivity bola 39,5 mesiacov (12–134 mesiacov) od začatia anticytokínovej terapie. Klinicky manifestná aktívna TB sa potvrdila u jedného pacienta. Štatistická analýza nepreukázala asociáciu medzi rizikom LTBI a vekom, pohlavím alebo liečebnou modalitou.

Záver: Výsledky tejto štúdie potvrdzujú opodstatnenie skríningu a stáleho monitorovania LTBI u pacientov s RA liečených anticytokínovou terapiou. Naše aktuálne národné odporúčania sú dostatočne senzitívne na identifikáciu LTBI. Nezodpovedanou otázkou zostáva potreba skríningu a profylaktickej liečby antituberkulotikami u pacientov liečených csDMARD v kombinácii s glukokortikoidmi.

Klíčová slova:

IGRA test – infekcia mykobaktériami – biologická liečba – latentná tuberkulózna infekcia

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