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Aktuelle Dermatologie 2008; 34(6): 231-235
DOI: 10.1055/s-2008-1077358
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Zum Stellenwert der neuen In-vitro-Bluttests für das Tuberkulosescreening vor Gabe von TNF-α-Inhibitoren bei Psoriasis

Utility of the New In-Vitro Blood Tests in Screening for Tuberculosis Prior to the Initiation of TNF-α-Inhibitors for the Treatment of PsoriasisR.  Diel1 , S.  Gadola2
  • 1Institut für Medizinische Soziologie, Heinrich-Heine-Universität Düsseldorf
  • 2School of Medicine, Department Infection, Inflammation and Repair, University of Southampton, UK
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Publication History

Publication Date:
07 July 2008 (online)

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Zusammenfassung

Aufgrund des erhöhten Tuberkuloserisikos beim Einsatz von TNF-α-Inhibitoren bei der Behandlung der Psoriasis vulgaris bzw. der Psoriasisarthritis sollte bei allen Patienten eine aktive TB ausgeschlossen werden und ein Screening auf Vorliegen einer latenten TB (LTBI) vor TNF-α-Therapie erfolgen. Das Screening sollte eine Röntgen-Thorax-Aufnahme, eine sorgfältigen Anamnese und die Durchführung eines hochspezifischen Interferon-Gamma Release Assays (IGRA) umfassen. Da sowohl falsch positive als auch falsch negative Tuberkulinhauttest (THT)-Ergebnisse in diesen Patientengruppen erwartet werden können, wird der früher häufig durchgeführte THT nicht mehr empfohlen. Die Behandlung der LTBI bei positivem IGRA umfasst grundsätzlich eine Chemoprävention mit Isoniazid (INH) über 9 Monate.

Abstract

Due to the elevated risk of tuberculosis in patients under treatment with TNF-alpha-inhibitors for the treatment of Psoriasis vulgaris or Psoriasisarthris, all patients should undergo examination to exclude active TB, and screening of all patients should be undertaken to detect eventual cases of latent TB (LTBI) prior to the beginning of TNF-α therapy. Screening should consist of a chest X-ray, a careful evaluation of risk factors and a blood test by means of a highly specific IGRA test. Because both-false positive and false-negative results must be expected when using the tuberculin skin test in this patient population, that test is no longer recommended. Treatment of LTBI in the case of a positive IGRA-Test consits, generally, of a 9-month course of chemoprevention with INH.

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PD Dr. Roland Diel

Institut für Medizinische Soziologie
Heinrich-Heine-Universität Düsseldorf

Postfach 10 10 07
40001 Düsseldorf

Email: Roland.Diel@uni-duesseldorf.de