{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T10:56:15Z","timestamp":1752231375451,"version":"3.37.3"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,5,19]],"date-time":"2017-05-19T00:00:00Z","timestamp":1495152000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>The tuberculin skin test (<jats:styled-content style=\"fixed-case\">TST<\/jats:styled-content>) is used to diagnose tuberculosis; however, the influence of tumor necrosis factor (<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>) inhibitors on the test is unclear. This study investigated whether therapy with <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> inhibitors suppresses the <jats:styled-content style=\"fixed-case\">TST<\/jats:styled-content> reaction due to immunosuppression or whether the <jats:styled-content style=\"fixed-case\">TST<\/jats:styled-content> reaction increases due to reactivation of latent <jats:italic>Mycobacterium tuberculosis<\/jats:italic> infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Ninety\u2010one patients with rheumatoid arthritis receiving <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> inhibitors (40 using infliximab and 51 using etanercept) were studied. The <jats:styled-content style=\"fixed-case\">TST<\/jats:styled-content> was performed before starting <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> inhibitors (T1) and more than 1\u00a0year after starting them (T2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At T1, the reaction was negative in 45 patients, weakly positive in 21 patients, moderately positive in 18 patients and strongly positive in seven patients, while the numbers at T2 were 44, 20, 16 and 11, respectively. There were no significant differences of the <jats:styled-content style=\"fixed-case\">TST<\/jats:styled-content> reaction between T1 and T2 in all patients (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.657), patients using infliximab (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.462) or patients using etanercept (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>1.00). No patients with a strongly positive <jats:styled-content style=\"fixed-case\">TST<\/jats:styled-content> reaction at T1 became negative at T2. However, two patients who were negative at T1 became strongly positive at T2. Although they had no signs of <jats:italic>M.\u00a0tuberculosis<\/jats:italic> infection, isoniazid prophylaxis was given.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">TST<\/jats:styled-content> reaction was not suppressed after more than 1\u00a0year of therapy with <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content> inhibitors. Patients in whom the <jats:styled-content style=\"fixed-case\">TST<\/jats:styled-content> reaction changes from negative to strongly positive may need appropriate prophylaxis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1756-185x.13101","type":"journal-article","created":{"date-parts":[[2017,5,19]],"date-time":"2017-05-19T11:23:28Z","timestamp":1495193008000},"page":"584-588","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Unaffected reaction level in tuberculin skin test by long\u2010term therapy with tumor necrosis factor inhibitors for rheumatoid arthritis"],"prefix":"10.1111","volume":"20","author":[{"given":"Shotaro","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Division of Rheumatology and Clinical Immunology Department of Medicine Jichi Medical University Shimotsuke Tochigi 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