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Poor agreement between QuantiFERON-TB Gold test and tuberculin skin test results for the diagnosis of latent tuberculosis infection in rheumatoid arthritis patients and healthy controls

The Korean Journal of Internal Medicine 2014년 29권 1호 p.76 ~ p.84

이주현(Lee Joo-Hyun) - Inje University Ilsan Paik Hospital Department of Internal Medicine
손혜숙(Sohn Hae-Sook) - Inje University College of Medicine Department of Preventive Medicine
전진호(Chun Jin-Ho) - Inje University College of Medicine Department of Preventive Medicine
김현아(Kim Hyoun-Ah) - Ajou University School of Medicine Department of Rheumatology
서창희(Suh Chang-Hee) - Ajou University School of Medicine Department of Rheumatology
이윤우(Lee Yun-Woo) - Withus Medical Clinic
윤보영(Yoon Bo-Young) - Inje University Ilsan Paik Hospital Department of Internal Medicine

Abstract

Background/Aims: We investigated the agreement between the QuantiFERON-TB Gold (QFT-Gold) test and the tuberculin skin test (TST) in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis (RA), compared with healthy controls, in Korea.

Methods: We recruited 64 patients with RA and 79 healthy controls at two university hospitals in South Korea. The participants underwent both the QFT-Gold test and the TST simultaneously between August 2006 and February 2009. All patients were diagnosed using the classification criteria for RA revised in 1987 by the American College of Rheumatology. Bacillus Calmette-Guerin vaccination status and current medications were evaluated, and disease activities were assessed using the Disease Activity Score in 28 joints. Eleven patients with RA produced indeterminate QFT-Gold test results and were thus excluded from the kappa analysis.

Results: Based on an induration of 10 mm in diameter as the TST cutoff value, the QFT-Gold test and TST demonstrated 75.0% agreement (κ = 0.23) in patients with RA and 75.9% agreement (κ = 0.19) in healthy controls. Among the 56 patients with RA who had negative TST results, 11 patients (17.2%) also yielded indeterminate QFT-Gold results.

Conclusions: Our study showed poor agreement between the results of the QFT-Gold test and the TST in both RA patients and healthy controls. Based on these findings, we emphasize the importance of making clinical decisions in the diagnosis of latent tuberculosis in Koreans with or without RA.