Abstract
ObjectiveWe aimed to determine the risk of tuberculosis in children with juvenile idiopathic arthritis (JIA) in Taiwan.MethodsWe used the Taiwan National Health Insurance Research Database (NHIRD) to conduct a nested case-control study. We identified a JIA cohort and matched each JIA child with non-JIA children for comparison. Methotrexate (MTX), tumor necrosis factor (TNF) inhibitor administration, and new tuberculosis cases were determined during our study period. To compare tuberculosis (TB) risk among our study groups, Cox proportional regression models were used to determine adjusted hazard ratios (aHRs).ResultsWe identified 1495 children with JIA and 11592 non-JIA children. Majority (68.7%) children with JIA had not received MTX or TNF inhibitors; 23.9% used MTX without TNF inhibitors, and 7.4% received TNF inhibitors, irrespective of MTX administration. In total, 43 children developed tuberculosis. The overall tuberculosis infection rate for children with JIA was two times higher than that for non-JIA children. Compared with non-JIA children, children with JIA who used MTX without TNF inhibitors revealed a significantly increased of tuberculosis infection rate (aHR = 4.67; 95% CI: 1.65–13.17; P = 0.004). Children with JIA who either received TNF inhibitors or never used MTX and TNF inhibitors revealed a tuberculosis infection rate comparable to that of non-JIA children.ConclusionsAnalysis of nationwide data of Taiwan suggested that children with JIA were at higher risk of tuberculosis compared with those without JIA.
Highlights
Compared with non-juvenile idiopathic arthritis (JIA) children, children with JIA who used MTX without tumor necrosis factor (TNF) inhibitors revealed a significantly increased of tuberculosis infection rate
Analysis of nationwide data of Taiwan suggested that children with JIA were at higher risk of tuberculosis compared with those without JIA
Anti-tumor necrosis factor (TNF) therapy was a breakthrough in managing juvenile idiopathic arthritis (JIA)
Summary
Anti-tumor necrosis factor (TNF) therapy was a breakthrough in managing juvenile idiopathic arthritis (JIA). Population-based studies have indicated that TNF inhibitors increase the risk of tuberculosis (TB) for adults with rheumatoid arthritis (RA) [1,2,3,4]. Despite the extensive use of biologics in pediatrics, the relationship between TB and JIA remains unclear, in TB-endemic areas. JIA is the most common pediatric rheumatic disease, with an incidence of 3.80–4.93 per 100,000 in Taiwan [5, 6]. JIA leads to morbidities such as joint deformities, uveitis, and altered lipid profiles and increases the risk of cardiovascular diseases [7, 8]. Medical advances have attempted to improve outcomes of JIA, infections, TB, remain a major concern for pediatric rheumatologists
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