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Background: The frequency of rescreening and monitoring for latent tuberculosis (TB) infection (LTBI) in patients with inflammatory arthritis on biological therapy is uncertain. Some health authorities recommend annual LTBI screening for patients who initially test negative. Objectives: The aim of this study was to evaluate the effectiveness of LTBI rescreening using the IGRA method and to assess the frequency of rescreening in real-life spondyloarthritis (SpA) patients on biological therapy. Methods: This study focused on patients with SpA who were scheduled for b-DMARD treatment and underwent QFT-Plus testing to screen for latent tuberculosis infection (LTBI). The study recorded demographic information, blood chemistry test results, comorbidities, and smoking status of the patients along with the QFT-Plus test. The results of the QFT-Plus test were analysed as positive, negative, or indeterminate. The study also analysed whether IGRA-negative patients underwent repeat IGRA tests during follow-up and the timing of these tests. Cases of tuberculosis reactivation during follow-up were documented, and the clinical status of affected patients was recorded. The study also investigated the management of patients who initially tested negative for IGRA but tested positive on subsequent follow-up tests, even if they did not show symptoms of active tuberculosis. Results: Of the 946 patients included in the study, 534 (56.4%) were female and the median age was 41 years (min:18-max:80). The QFT-Plus test was positive in 107 (11.3%) patients and negative in 827 (87.4%) (Figure 1). The median duration of disease follow-up for initial IGRA negative patients was 27 months (min-max: 0-52). Follow-up tests were carried out only 67 (%8.1) of the 827 initial IGRA negative patients. Among them, 65 patients had negative results, while two asymptomatic patient was positive for rescreening test and they continued their biological treatment while receiving INH prophylaxis. Remarkably, only one patient (0.13%), who was IGRA negative at the initation of biological treatment and did not undergo a follow-up test, exhibited positivity for TB in a sputum culture at the 27th month of follow-up (Figure 2). Conclusion: This study found that compliance with annual testing was particularly low in patients without LTBI. On the other hand, the occurrence of TB infection or activation in IGRA-negative patients was extremely rare over a median follow-up of 27 months. These results suggest that national and international guidelines may need to be updated to reflect real-world data and clinical practice. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.
Özsoy et al. (Sat,) studied this question.