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Is Takayasu arteritis the result of a Mycobacterium tuberculosis infection? The use of TNF inhibitors may be the proof-of-concept to demonstrate that this association is epiphenomenal

  • Perspectives in Rheumatology
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Abstract

Although the association between Takayasu arteritis (TA) and latent or active Mycobacterium tuberculosis infection has been suggested for a long time, studies conducted in recent years are challenging this notion. Until recently, the possibility of a pathogenic relationship between TA and tuberculosis (TB) was considered a medical curiosity, but the advent of tumor necrosis factor (TNF) inhibitors as therapy for recalcitrant TA cases, as well as the widespread use of Bacille Calmette-Guérin (BCG) for vaccination purposes, has relocated this association as a top priority issue. In an attempt to define whether both diseases are pathogenically linked or if their association is only epiphenomenal in nature, we conduct a thorough literature search on the development of TB in patients with TA receiving TNF inhibitors. From a total of 13 studies that included 214 patients, the occurrence of TB was observed only in two individuals exposed to infliximab. This frequency of 0.93% is similar to that encountered in patients with other rheumatic diseases exposed to TNF inhibitors. Finally, we propose a novel pathogenic model that could reconcile the epidemiological, clinical, and immunological evidence that links TA and TB, while providing rationality for the use of TNF inhibitors in patients with TA.

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Author notes

  1. Diana Castillo-Martínez and Luis M. Amezcua-Castillo contributed equally to this work.

Authors and Affiliations

  1. Dermatology Clinic, Hospital General de Zona 32, Instituto Mexicano del Seguro Social, Mexico City, Mexico

    Diana Castillo-Martínez

  2. School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico

    Luis M. Amezcua-Castillo

  3. Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico

    Julio Granados

  4. Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Carlos Pineda

  5. Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, 14080 Tlalpan, Mexico City, Mexico

    Luis M. Amezcua-Guerra

  6. Department of Health Care, Universidad Autónoma Metropolitana–Xochimilco, Mexico City, Mexico

    Luis M. Amezcua-Guerra

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  1. Diana Castillo-Martínez
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Correspondence to Luis M. Amezcua-Guerra.

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Castillo-Martínez, D., Amezcua-Castillo, L.M., Granados, J. et al. Is Takayasu arteritis the result of a Mycobacterium tuberculosis infection? The use of TNF inhibitors may be the proof-of-concept to demonstrate that this association is epiphenomenal. Clin Rheumatol 39, 2003–2009 (2020). https://doi.org/10.1007/s10067-020-05045-z

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