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A retrospective study on the risk of tuberculosis in patients with rheumatoid arthritis

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Abstract

Tuberculosis (TB) is an important preventable infection in patients with rheumatoid arthritis (RA). To determine the risk of TB in patients with RA by comparing with those with non-specific back pain (NSBP), and to identify the risk factors in the RA group. Medical data were retrieved from a centralized electronic database. A total of 1099 patients with RA and 2489 patients with NSBP were identified. Clinical data, comorbidities, and use of individual disease-modifying anti-rheumatic drugs (DMARDs) were retrieved. Risks of TB in patients with RA and NSBP were compared by propensity score (PS) adjusted analysis with known or potential risk factors for TB. Risk factors of TB were also determined in patients with RA. There were 14 cases of TB in RA group and 25 cases in NSBP group. Median duration of follow-up were 11.3 (0.1–21.9) years in RA group and 15.4 (0.1–24.4) years in NSBP group. The risk of TB in patients with RA was 2.53 times higher (HR 2.53; 95% CI 1.29, 4.94; p < 0.01) than in patients with NSBP. After excluding patients on DMARDs, the risk became similar (HR 2.72; 95% CI 0.81, 9.14; p = 0.11). Independent risk factors found were etanercept (HR 7.16; 95% CI 1.41, 36.30; p = 0.02), and previous TB infection (HR 25.23; 95% CI 6.99, 91.09; p < 0.001). The risk of extrapulmonary involvement between RA and NSBP groups was similar (HR 1.21; 95% CI 0.22, 6.57; p = 0.83). The risk of TB was increased in patients with RA. Anti-TNF therapy was an identified risk factor.

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Authors and Affiliations

  1. Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China

    Tin Tsun Chung, Ho Juen Ko, Chak Sing Lau & Ho Yin Chung

  2. University College London, London, UK

    Ho Juen Ko

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  1. Tin Tsun Chung
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Contributions

TTC was responsible for acquisition and analysis of data, and drafting the manuscript. HJK was responsible for the acquisition and analysis of data, and critical revision of the manuscript. CSL was responsible for the design of the study, and critical revision of the manuscript. HYC was responsible for the design of the study, acquisition and analysis of data, and drafting the manuscript. All co-authors are familiar with the final version of the manuscript and take full responsibility for the integrity of the study and all parts of the manuscript.

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Correspondence to Ho Yin Chung.

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The authors have no competing interests to declare.

Ethics approval

The study was approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (reference number UW 18-263; date of approval: 18th April 2018). It was conducted in accordance with the Declaration of Helsinki and the guidance of Good Clinical Practice, November 30, 2006. Written consent was waived the institutional review board during data collection.

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Data are available from Dr Ho Yin Chung upon reasonable request.

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Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.

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Chung, T.T., Ko, H.J., Lau, C.S. et al. A retrospective study on the risk of tuberculosis in patients with rheumatoid arthritis. Rheumatol Int 40, 983–990 (2020). https://doi.org/10.1007/s00296-020-04583-8

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  • DOI: https://doi.org/10.1007/s00296-020-04583-8

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