RESEARCH - Attenuated response to PPD skin test in those with RA

August 24, 2005

Ann Rheum Dis. 2005 Sep;64(9):1360-1.

Attenuated response to purified protein derivative in patients with

rheumatoid arthritis: study in a population with a high prevalence of

tuberculosis.

Ponce de Leon D, Acevedo-Vasquez E, - A, Cucho M, Alfaro J,

Perich R, Pastor C, on J, -Schwartz C.

Academic Department of Rheumatology, Hospital Nacional, Guillermo Almenara

Irigoyen, Avenida Grau 800, La , Lima, Peru. edacvas@....

BACKGROUND: The purified protein derivative (PPD) skin test is the only

widely used method which detects latent tuberculosis infection (LTBI) and is

dependent on a normal T cell function. In rheumatoid arthritis (RA) the T

cell function is altered, which may result in an inability to develop an

adequate PPD reaction. OBJECTIVES: To evaluate the response to PPD in

patients with RA and to compare it with that of control subjects. METHODS:

112 patients with RA and 96 healthy controls were studied. PPD 5 U was

applied using the Mantoux method, and skin reaction was measured at 72

hours. The reaction was considered negative for PPD <5 mm. RESULTS: There

were no significant differences in age, sex, history of bacille

Calmette-Guerin vaccination, or tuberculosis contact between the two groups.

The median size of the PPD induration in the patients with RA was

significantly less than that in the control group (4.5 v 11.5 mm, p<0.01).

79 (70.6%) patients with RA compared with 25 (26%) of the control group had

a negative reaction to PPD (p<0.01), a response not influenced by disease

activity or duration of disease in the patients with RA.

CONCLUSION: A PPD skin test is not an appropriate test for recognising LTBI

in patients with RA in our population.

PMID: 16100342

6100342 & dopt=Abstract

Not an MD

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Mayo Clinic in Rochester

s Hopkins Medicine

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