Share This Article:

Evaluation of Tuberculin Skin Test Response and Interfering Factors in Patients with Juvenile Idiopathic Arthritis

Abstract Full-Text HTML XML Download Download as PDF (Size:188KB) PP. 181-184
DOI: 10.4236/ojra.2013.34028    2,376 Downloads   3,881 Views  

ABSTRACT

Juvenile idiopathic arthritis (JIA) is the most common rheumatologic disease in pediatric age group. Mycobacterium tuberculosis infection (TB) is an important cause of mortality and morbidity in patients with inflammatory rheumatologic disease. The objective of this study is to determine to what extent active disease and use of drugs in JIA affects response to PPD skin test and thus to investigate the significance of PPD skin test in the diagnosis of latent TB. 77 children diagnosed with JIA according to ILAR diagnostic criteria and routinely followed by our rheumatology clinic were included in the patient group. Patients were grouped according to subtypes of disease, activity status and drugs they used. Control group was formed from 58 healthy children. PPD skin test was applied to each subject and the number of BCG scars of all cases was recorded. We found no significant difference in PPD induration diameters between JIA and control group (p > 0.05). The number of BCG scar is similar in both groups. In the control group, age and number of BCG scars and PPD skin test diameter are positively correlated. But there is no such significant relationship in patients with JIA (p > 0.05). PPD induration diameter of patients with active disease is significantly shorter than patients in remission (p > 0.05). PPD induration diameter of patients treated with steroid and disease modifying anti-rheumatic drug (DMARD) and underwent remission were not significantly different from the control group. When compared with patients using other drugs, patients on remission using steroid and DMARD have shorter PPD induration diameter. Activity of disease and drugs used (steroid, DMARD) affects PPD response. In the diagnosis of latent TB, normal range of PPD diameter in healthy child changes in JIA patient with active disease. That the PPD diameter is shorter than normal range could indicate underlying TB infection. This fact should be considered in the follow-up of the patients with JIA.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

I. Şimşek, M. Ergüven and O. Dağcı, "Evaluation of Tuberculin Skin Test Response and Interfering Factors in Patients with Juvenile Idiopathic Arthritis," Open Journal of Rheumatology and Autoimmune Diseases, Vol. 3 No. 4, 2013, pp. 181-184. doi: 10.4236/ojra.2013.34028.

References

[1] T. J. Cassidy and R. E. Patty, “Juvenile Rheumatoid Arthritis. Textbook of Pediatric Rheumatology,” 3rd Edition, W. B. Saunders, 1995, pp. 133-223.
[2] R. N. Lipnick, G. C. Tsokov and D. B. Maglavy, “Immune Abnormalities in the Pathogenesis of Juvenile Rheumatoid Arthritis,” Rheumatic Disease Clinics of North America, Vol. 17, 1991, pp. 703-859.
[3] D. Ponce de Leon, E. Acevedo-Vasquez, A. Sanchez-Torres, et al., “Attenuated Response to Purified Protein Derivative in Patients with Rheumatoid Arthritis: Study in a Population with a High Prevalence of Tuberculosis,” Annals of the Rheumatic Diseases, Vol. 64, 2005, pp. 1360-1361. http://dx.doi.org/10.1136/ard.2004.029041
[4] Turkish Ministry of Health Division of Tuberculosis, “Incidence of Tuberculosis and Number of Cases over Years,” 2000.
[5] American Academy of Pediatrics, “Report of the Committee on Infectious Disease. Red Book,” 24th Edition, 1997, p. 544.
[6] F. Wolfe, K. Michaud, J. Anderson and K. Urbansky, “Tuberculosis Infection in Patients with Rheumatoid Arthritis and the Effect of Infliximab Therapy,” Arthritis & Rheumatism, Vol. 2, 2004, pp. 372-379. http://dx.doi.org/10.1002/art.20009
[7] H. Güvenc, A. Koc and O. Ozkarakas, “PPD Skin Testing in Schoolchildren with and without BCG Vaccination,” Turkish Journal of Medical Research, Vol. 11, No. 3, 1993, pp. 116-119.
[8] A. Koc and T. Karagoz, “Tüberkülozda Epidemiyolojik Olcütler ve Hasta Grubu Analizi,” Solunum Hastaliklarn Dergisi, Vol. 8, No. 4, 1997, pp. 621-634.
[9] R. L. Sepulveda, X. Ferrer and R. U. Sorensen, “The Influence of Calmette Guerin Bacillus Immunization on the Booster Effect to Tuberculin Testing in Healthy Young Adults,” The American Review of Respiratory Disease, Vol. 142, 1990, pp. 24-28. http://dx.doi.org/10.1164/ajrccm/142.1.24
[10] G. W. Comstock, L. B. Edwards and X. T. Nabang, “Tuberculin Sensitivity Eight to Fifteen Years after BCG Vaccination,” The American Review of Respiratory Disease, Vol. 103, 1971, pp. 572-575.
[11] E. S. Ucan, C. Sevinc and O. Abadoglu, “Tüberkülin Testi Sonuclarinin Yorumlanmasi ülkemiz Standartlari ve yeni Gereksinimler,” Toraks Dergisi, Vol. 1, 2000, pp. 25-29.
[12] E. Bozkanat, F. Ciftci, M. Apaydin, Z. Kartaloglu, E. Tozkoparan, O. Deniz and O. Sezer, “Tuberculin Skin Test Screening in a Military School in Istanbul City Center.”
[13] A. Sakar, T. Goktalay, L. Dagyildizi and A. C. Yildirim, “Manisa Ilinde Tüberküloz Taramasi,” Toraks Dergisi, 2001.
[14] J. Waxman, M. D. Lockshin, J. J. Schnapp and I. N. Doneson, “Cellular Immunity in Rheumatic Diseases I. Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 4, 1974, pp. 499-506.
[15] H. M. Hoyeraal, “Impaired Delayed Hypersensitivity in Jüvenile Rheumatoid Arthritis,” Annals of the Rheumatic Diseases, Vol. 32, 1973, p. 331. http://dx.doi.org/10.1136/ard.32.4.331
[16] J. R. Hayes, D. J. Ward and J. F. Jennings, “Studies on Cell-Mediated Hypersensitivity Responses in Rheumatoid Arthritis,” Proceedings of the Third Symposium, 1970.
[17] M. G. Helliwell, G. S. Panayi and A. Unger, “Delayed Cutaneous Hypersensitivity in Rheumatoid Arthritis: The Influence of Nutrition and Drug Therapy,” Clinical Rheumatology, Vol. 1, 1984, pp. 39-45. http://dx.doi.org/10.1007/BF02715694
[18] E. Kiray, O. Kasapcopur, V. Bas, et al., “Purified Protein Derivative Response in Juvenile Idiopathic Arthritis,” Journal of Rheumatology, Vol. 36, 2009, pp. 2029-2032. http://dx.doi.org/10.3899/jrheum.090173
[19] I. Sezer, H. Kocabas, M. A. Melikoglu and M. Arman, “Positiveness of Purified Protein Derivatives in Rheumatoid Arthritis Patients Who Are Not Receiving Immuno-suppressive Therapy,” Clinical Rheumatology, Vol. 28, 2009, pp. 53-55. http://dx.doi.org/10.1007/s10067-008-0982-1

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.