Clinical Utility of MBDA Panel in the Management of Adult Onset Still's Disease [Case Report]
BACKGROUND:Adult Onset Still's disease (AOSD) carries an expansive presentation - typically featuring a triad of fevers, myalgia/arthralgia, and a rash - which can be mistaken for infectious or malignant etiology. As such, the role of reliable biomarkers becomes critical in the diagnosis and management of AOSD. The employment of MBDA panel may be of clinical utility in AOSD management, as we describe two cases where its application drives treatment plan. METHODS:We describe two cases where application of MBDA panel - such as Vectra DA -assisted with disease management. RESULTS:Case 1 features a 68-year-old male who presented with recurrent fevers, malaise, and a rash for three weeks. He was found to have an elevated ferritin level (15,599 ng/mL) with elevated acute phase reactants, consistent with AOSD. Vectra DA score was 77 at time of diagnosis. After treatment (see table), repeat Vectra DA at follow-up was 15. Case 2 features a 25-year-old female with history of juvenile idiopathic arthritis (then inactive) who presented with fevers, malaise, and rash. She was found to have an elevated ferritin level (321 ng/mL) with elevated acute phase reactants, also consistent with AOSD. Her Vectra DA score was 80 at peak of symptoms. She underwent appropriate treatment (see table), and repeat Vectra DA at follow-up was 17. CONCLUSION/CONCLUSIONS:A deeper consideration should be placed on the value of MBDA as a monitoring tool in the management of AOSD, specifically when pertaining to patient's responsiveness to therapies.
Screening Optimization of Latent Tuberculosis Infection in Rheumatoid Arthritis Patients
Objective. Rheumatoid arthritis (RA) patients are at increased risk of latent tuberculosis infection (LTBI) but there are no clear guidelines for LTBI screening with Tuberculin Skin Test (TST) or Quantiferon TB Gold testing (QFT-G). Methods. A retrospective study was conducted in a high risk, largely foreign-born, inner city, RA population. After screening 280 RA patients, 134 patients who had both TST and QFT-G testing performed during their initial evaluation were included. Results. Out of 132 RA patients included in our analysis, 50 (37.8%) patients were diagnosed with LTBI with either positive TST 42 (31.8%) or QFT-G 23 (17.4%). 15 (11.4%) were positive and 82 (62.1%) were negative for both tests. The agreement between TST and QFT-G was 73.5% (Kappa 0.305, CI = 95% 0.147-0.463, p = 0.081). Conclusions. There was low-moderate agreement (kappa = 0.305) between TST and QFT-G. In the absence of clearly defined gold standard and limitations associated with both tests, we propose early screening with both tests for patients who need prompt treatment with BRMs. Patients who are not immediate candidates for BRM treatment may be safely and cost effectively screened with a two-step process: initial screening with TST and if negative, IGRA testing. Patients positive for either test should be promptly treated.