Abstract
Background/ objectiveTuberculosis (TB) is one of the most infectious comorbidities in spondyloarthritis (SpA). Our goals were to determine the crude incidence rate of and risk factors for TB in SpA.MethodClinical data of 2984 patients with SpA from 11 rheumatology centres were reviewed. This included demographics, duration of follow-up, comorbidities including diabetes, chronic kidney disease, chronic heart disease, chronic lung disease, stroke and malignancies, date of diagnosis of tuberculosis, use of non-steroidal anti-inflammatory drugs, duration of glucocorticoid therapy for more than 6 months, conventional (cDMARD) and biological (bDMARD) disease modifying anti-rheumatic drug therapies. Crude incidence rates were reported. Cox regression models were used to determine the risk factors for TB in patients with SpA.ResultsForty-three patients had TB, of which 4 (9.3%) were extra-pulmonary. The crude incidence rate of TB was 1.57 in patients with SpA, compared with 0.58 in the general population in Hong Kong. Independent risk factors identified from the multivariate Cox regression model were: alcohol use (HR 2.62; p = 0.03), previous TB (HR 13.62; p < 0.001), chronic lung disease (HR 3.39; p = 0.004), duration of glucocorticoid therapy greater than 6 months (HR 3.25; p = 0.01) and infliximab therapy (HR 5.06; p < 0.001). Age was associated with decreased risk (HR 0.93; p < 0.001).ConclusionIncidence of TB was higher in patients with SpA. Glucocorticoid therapy beyond 6 months and infliximab therapy increased the risk of TB. Rheumatologists should avoid prolonged use of glucocorticoids and consider DMARDs other than infliximab in the treatment of at-risk patients.
Highlights
Spondyloarthritis (SpA) is a spectrum of inflammatory rheumatic diseases comprised of ankylosing spondylitis (AS), psoriatic arthritis (PsA), enteropathic arthritis associated with inflammatory bowel disease (IBD), reactive arthritis, undifferentiated spondyloarthritis and human leucocyte antigen B27 (HLA-B27) associatedTuberculosis (TB) is one of the most important infectious comorbidities in SpA
Independent risk factors identified from the multivariate Cox regression model were: alcohol use (HR 2.62; p = 0.03), previous TB (HR 13.62; p < 0.001), chronic lung disease (HR 3.39; p = 0.004), duration of glucocorticoid therapy greater than 6 months (HR 3.25; p = 0.01) and infliximab therapy (HR 5.06; p < 0.001)
Glucocorticoid therapy beyond 6 months and infliximab therapy increased the risk of TB
Summary
Spondyloarthritis (SpA) is a spectrum of inflammatory rheumatic diseases comprised of ankylosing spondylitis (AS), psoriatic arthritis (PsA), enteropathic arthritis associated with inflammatory bowel disease (IBD), reactive arthritis, undifferentiated spondyloarthritis (uSpA) and human leucocyte antigen B27 (HLA-B27) associatedTuberculosis (TB) is one of the most important infectious comorbidities in SpA. Previous studies have shown increased rates of TB in AS [4, 5], PsA [6] and other subtypes of SpA [7], and in patients on tumour necrosis factor inhibitor (TNFi) therapy [8, 9]. South Korean data found more TB in AS patients on TNFi therapy, with incidence rate ratios of 4.87 compared with other drug. The crude incidence rate of TB in the general population in Hong Kong was 58.1 per 100,000 in 2018 [11], much higher than in western populations. TNFi therapy is known to trigger reactivation of latent TB [12, 13], yet conventionally used to treat SpA. Biologic drugs other than TNFi are increasingly prescribed due to lower risk of TB [14]
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