Scared-Quantiferon test back postive- | Arthritis Information
I was supposed to start Enbrel. TB skin test negative, chest xray fine, but just got a call that the Quantiferon test is positive. She said the prednisone can cause a fals skin test. I traveled to Africa a few years back and wonder if i caught it there? My options she said are to go on TB therapy for 9 months and start Enbrel after the first month on this, or try a new combination of meds.
I'm so depressed, scared and frustrated. Another road block. My RA has gotten worse and looking forward to the Enbrel.
Anyone have a TB test positvie and have to go through the TB therapy?
Minor setback. See if they'll ween(sp?) you off the pred so you can retake the test. :) If the test does come back positive, the only info I have on TB therapy is that you cannot drink while taking the meds. I had a friend who tested positive and had to take meds for about 6mos and that was the only issue he had with it.
Don't worry. Everything is going to be ok. :) Are you at the max dose of MTX?
Hi CO_Mel-
Thanks for writing back. Im hurting so bad she doesnt want to take me off prednisone until i'm on something else that helps put my RA under control more. Did your friend say the meds he took for TB were bad? I've heard they are very hard on your body? Was he then able to get on to Enbrel? I guess I worry after the TB meds, that it will still activate the TB. The meds dont get rid of TB right? Ohh, so many questions!
I'm on 12.5mg mtx but have side affects from it and wanted to get off of it.
I'm sorry to hear you're in such bad shape. :( That's just frustrating to hear you can't go off the pred, especially if it's the culprit causing a false positive! The guy I knew didn't have RA. He was in the military and tested positive several years ago. He didn't really complain about any side effects (although he did look a little green after eating so I'm thinking the meds probably caused some stomach upset.) Him saying he wasn't able to drink alcohol was the only thing I really remember about the meds. I'm sorry I don't know more about them. Has your doc suggested any RA meds other than Enbrel? Also, how long have you been on the MTX? Sometimes you get side effects for the first 6-8 weeks and they slowly taper off as your body adjusts.
just relax. Just about anyone who has lived in a big city or travelled to a TB endemic area will show a positive skin test. I was told never to get another one. Just X-ray to rule it out. It probably means that you've had exposure, but not the TB itself.
My doc said that if I did Enbrel, I'd have to take the medication for 9-months before i received the Enbrel. But I never had any faith in her anyway.....Isaland Woman: I'm trying to relax ... Just tired of all the road blocks... I didnt realize so many people have been exposed to TB until I started reading up on it. My dr also said I could take the tb meds for 9 months but could start enbrel after a month if i tolerated the tb meds which I thought was strange..one month? Just worries me that I could make theTB active if I start it even after the tb meds.
Co_Mel: Im going to see my Rheumy today to discuss all this. Been on MTX since I think September, but smaller doses. my RA is getting worse each week though, so my Rheumy thinks the mtx isnt working for me like it should be by now.
Klynn, if I remember correctly you're on a very small dose of MXT and that has a lot of room for adjustment. I had a positive skin test when I was 25 years old and working emergency and surgery in a county hospital. I didn't have RA at the time but I did go on meds and had no problems. I haven't had a positive skin test since, even though we've spent most of the last 4 years in Mexico. Let us know what your RD says today. LindyHi Lindy: Yep I'm only on 12.5 mg Mtx. I could probably keep trying to up the dose. Maybe it will just kick in later? My Rheumy and PCP talked with each other today, I spoke with both of them. They both said I need to start the TB meds for 9 months and after about 1 month on this , I can start Enbrel. Kelly,
Don't adjust the MTX dose without consulting your physician first. [You can often handle this by phone.]
Some years ago my brother and I were diagnosed with PsA at the same time, unbeknownst to one another. We each started MTX. Then Enbrel came out and my brother went on it with great success. So naturally I wanted it, too.
But I am TB-positive [LTBI]. As it was explained to me [I was about 55 at the time] that generally what happens is that they begin treatment for TB, then a month later they start the Enbrel. HOWEVER, they don't like to do the TB treatment in someone over age [50???] beause of liver toxicity. Ergo, I've been stuck on MTX.
I do know one person who underwent the TB treatment and then went on Enbrel. She told me that it [the drugs for TB] were a little uncomfortable, but in retrospect, SO WORTH THE DISCOMFORT because now she enjoys the Enbrel.
[Note: in you were older and had active TB, then it's a life threatening situation and they wouldn't hesitate to start treatment.]
That said, maybe it might be wise to up the MTX and give it a go.
There's another study [albeit small] that says that the risk for contracting hepatitis as a result of TB treatment is about 3%, regardless of age.
Here's info on the Quantiferon test.
Apparently there's a lot of opportunity for false readings if the blood sample is not processed according to strict protocol within 12 hours.
Sam12342009-12-17 17:56:29Hi Sam,
Thanks so much for the websites, Lots of great information! (still reading it)
Whats awful is , if there was an error in the QFT because they didnt process the test correctly, they are putting people through long tb treatment for no good reason. Guess there's no real way to ever find that out though. Better safe than sorry?
Something I didnt realize, My rheumy and pcp said they want me on this tb treatment because even if I didnt start Enbrel, there's a higher chance of my TB becomming active because I'm on other immune suppressing meds (mtx). Why doctors not test everyone as a precautionary screening that are taking Immune suppressing drugs, just to make sure they dont have Latent TB?
So because of your age, they wont treat you for TB? Can they treat you and monitor you closely so you can get on Enbrel?
I had to jump in here with another example. When my cousin retired at age 64 from a public service position, she decided to work in a nursing home as a hospice volunteer. Her skin test came back positive and the xray was not definitive. Her doctor sent her to a pulmonoligist who put her on a nine month program of 2 pills per day. She had absolutely no symptoms and continued her normal activities during this time. I hope this helps.
From reading here, it would seem that treatment varies from place to place.
Ann
I'm sure a lot of people don't have problems with the TB treatment. But I'd also be inclined to think that anyone who had been taking MTX for years has already done some damage to his liver. Then again, the liver is a forgiving organ and will regenerate.
Kelly, you asked a couple questions and I’d like to make a couple comments:
1. I THINK [don’t quote me on this] if you fail just one TB test you’re automatically referred for TB treatment [unless you’re truly latent and over the age of ???50???]
2. That your chest x-ray is clear doesn’t mean anything. TB is not restricted to the lungs. It could be anywhere in the body, including your big toe.
3. I had the fortune of contacting Dr. Richard Chaisson of Johns Hopkins and who is probably the foremost expert on TB in the US. During the course of our phone conversation I asked him what was the longest period of time from exposure to active TB that was on record. [I was exposed as a 4 year old and was thinking because so much time had passed that I no longer could get active TB.] His answer was 74 years.
4. MTX used in Rheumatology has to be used for some time before it does damage to the liver. My thinking is that as long as the liver function tests are normal, it’s ok to prescribe MTX [or other biologics that affect the liver]. But the reality is that TB can burst onto the scene quite suddenly.
5. In my case, due to my age they advise AGAINST treating me for TB while my disease is inactive because it will do further damage to my liver. If they were to treat me now, while I continue to take MTX, the TB drugs could be expected to damage the liver to the point where I would have to go off the MTX.......and it’s not known if my liver will heal. However, if I come down with the full-blown TB they will treat me because then they don’t have a choice. The benefit far exceeds the risk.
6.
Most rheumatologists continue to use MTX, though in smaller doses, along with the Enbrel. So no, it’s just not a case of giving me Isonazid [TB drug], Enbrel, and MTX and monitoring me.
7. For what it’s worth, when I started MTX 15+ years ago no one talked about TB or running the tests for same. [Heck, we didn't even know to use folic acid for the side effects back then!] Is it a good idea to test people before they begin MTX or other immunosuppressant drugs? Maybe. But then the doses used in rheumatology are generally not large enough [so I’m told] to activate the TB. Of course there must be exceptions to the rule. Maybe they’re finding out other things.
If it was me and I was younger than 50, I’d jump through the hoops, get the TB treatment and get started on Enbrel. In a heartbeat.
But you must make your own decision.
Will you keep us apprised of your decision and outcome?
Sam12342009-12-18 17:46:38Hi Sam,
I really appreciate all the information you always throw our way! It really does help, thank you!
I decided to make an appt (this thurs) with an infectious disease dr. That was one of the options my Rheumy gave to me and thought before I start this 9 month course of TB meds, which are so horrible for your liver, and am now reading i need to stay away from cheese, sour cream, even chocolate God forbid while on these meds (can cause interactions), I think I will get his opinion and let him hopefully run some more tests to confirm the diagnosis and who knows, maybe he'll find something else that will shed some light on my situation??.. I'll let you all know what comes of it.
Hopefully the infectious disease doc will have some good news. :)Hi, Klynn,
By all means, see the infectious disease specialist. That's what I did and am glad I did. The news wasn't what I wanted, but at least I got the facts. I didnt' know about having to stay away from all those food goodies. Ouch!
Can't wait to hear what you found out [since it's been a good five years or so since I saw the infectious disease specialist]. Maybe they've got some good tricks up their sleeves now.
Good luck.
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