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Clinical spectrum of active tuberculosis in patients with systemic lupus erythematosus

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Abstract

Introduction

There is paucity of data on tuberculosis in Indian patients with systemic lupus erythematosus (SLE). We retrospectively studied clinical features and outcome of tuberculosis in SLE.

Methods

Medical records of patients who developed tuberculosis simultaneous or after the diagnosis of SLE were retrospectively reviewed. All patients fulfilled 1997 ACR and/or SLICC 2012 classification criteria for SLE. A diagnosis of tuberculosis required bacteriological, histopathological or CT/MRI suggestive of tuberculosis and initiation of four drug antituberculous therapy. Baseline parameters were compared with the rest of cohort to identify predictors of tuberculosis.

Results

In our cohort of 1335 SLE patients, 48 (3.6%) developed tuberculosis. Incidence of tuberculosis was calculated to be 733 per 100,000 patient years and occurred after a mean disease duration of 3.0 ± 4.1 years. Extrapulmonary tuberculosis (n = 37) was commoner than pulmonary tuberculosis (n =11). Most common radiological pattern in pulmonary tuberculosis was miliary and musculoskeletal TB was most common extrapulmonary TB. A microbiological diagnosis was obtained in 52.1% patients. Male gender was associated with higher risk of tuberculosis [OR 3.30 (1.55-7.05)]. Mortality was 14.5% and all patients who died had either disseminated (n = 5) or central nervous system (CNS) tuberculosis (n = 2).

Conclusion

Incidence of tuberculosis in SLE is higher than general population and is associated with different phenotype and higher mortality. Male gender was associated with increased risk of tuberculosis in SLE.

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Author notes

  1. Hafis Muhammed

    Present address: Department of General Medicine, Government Medical College, Calicut, India

  2. Avinash Jain

    Present address: Division of Clinical Immunology and Rheumatology, SMS Medical College and Hospital, Jaipur, India

Authors and Affiliations

  1. Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India

    Hafis Muhammed, Avinash Jain, Sarit Sekhar Pattanaik, Rudrarpan Chatterjee, R. Naveen, Hina Kabeer, Latika Gupta, Durga P. Misra, Vikas Agarwal, Able Lawrence, Ramnath Misra & Amita Aggarwal

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  1. Hafis Muhammed
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Contributions

All authors contributed to the data. HM, AJ, RC, SSP, NR, HK extracted the data from records. HM and AJ wrote the first draft. SSP, RC, NR, HK modified the draft further. All authors approved the final version of the manuscript, take responsibility for the content of the entire manuscript, and affirm that any queries related to any aspect of the same are appropriately managed.

Corresponding author

Correspondence to Amita Aggarwal.

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The author declares that they have no conflicts of interest.

Ethical approval

The study was cleared by institute ethics committee. As this was a retrospective review of data, the requirement of patient consent was waived off by the committee (IEC Number-2020–148-IP-EXP-21).

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Muhammed, H., Jain, A., Pattanaik, S.S. et al. Clinical spectrum of active tuberculosis in patients with systemic lupus erythematosus. Rheumatol Int 41, 2185–2193 (2021). https://doi.org/10.1007/s00296-021-04933-0

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  • DOI: https://doi.org/10.1007/s00296-021-04933-0

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