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.

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 (kappa = 0.23) in patients with RA and 75.9% agreement (kappa = 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.