Interferon-inducible protein-10 as a marker to detect latent and active tuberculosis in rheumatoid arthritis
Abstract:SETTING: Effective tuberculosis (TB) screening should be performed before anti-tumour necrosis factor alpha (TNF-α) treatment in rheumatoid arthritis (RA). The usefulness of the tuberculin skin test (TST) and QuantiFERON®-TB Gold (QFT-G) for detecting latent tuberculosis infection (LTBI) is limited.
OBJECTIVE: We tested the diagnostic performance of interferon-gamma (IFN-γ) inducible protein 10 (IP-10) and IFN-γ for detecting LTBI in RA patients receiving anti-TNF-α treatment.
DESIGN: IP-10 levels were determined by enzyme-linked immunosorbent assay in 56 RA patients and 18 active TB patients. TST was performed using the Mantoux method and QFT-G was performed by measuring IFN-γ levels in whole blood treated with TB-specific antigens.
RESULTS: Twenty-four (42.9%) TST-positive patients were defined as having LTBI. Significantly higher levels of baseline, early secretory antigenic target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10) stimulated IP-10 were observed in active TB patients (median 209.9 pg/ml, 899.0 pg/ml and 880.2 pg/ml, respectively) and RA patients with LTBI (165.3 pg/ml, 904.4 pg/ml and 747.5 pg/ml, respectively), compared to those without LTBI (89.3 pg/ml, 579.4 pg/ml and 515.0 pg/ml, respectively). Baseline IP-10 has high sensitivity (83.3% and 100%) and medium specificity (67.9% and 59.6%), while ESAT-6-stimulated IP-10 has high sensitivity (87.5% and 100%) and specificity (85.7% and 71.2%) for detecting LTBI and TB. The performance of IP-10 is superior to IFN-γ for detecting LTBI (TST+) and active TB.
CONCLUSION: IP-10 may be used for detecting LTBI and as a potential biomarker to identify active TB in RA patients receiving anti-TNF-α treatment.
Document Type: Regular Paper
Affiliations: 1: Division of Respiratory and Critical Care Medicine, Taichung Veterans General Hospital, Taipei, Taiwan; and Department of Respiratory Therapy, China Medical University, Taipei, Taiwan 2: National Yang-Ming University, Taipei, Taiwan; Institute of Biomedical Science, National Chung-Hsing University, Taipei, Taiwan; and Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taipei, Taiwan 3: Institute of Biomedical Science, National Chung-Hsing University, Taipei, Taiwan; and Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taipei, Taiwan
Publication date: February 1, 2011
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