Tuberculosis in biologic-naïve patients with rheumatoid arthritis - risk factors and tuberculosis characteristics

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Karlsson Sundbaum, JohannaUppsala universitet,Luleå tekniska universitet,Hälsa, medicin och rehabilitering,Rheumatology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden,Reumatologi,Luleå Univ Technol, Dept Med Sci, Luleå, Sweden. (author)

Tuberculosis in biologic-naïve patients with rheumatoid arthritis - risk factors and tuberculosis characteristics

Article/chapterEnglish2021

Publisher, publication year, extent ...

2021-04-01
The Journal of Rheumatology Publishing Co. Ltd.2021
printrdacarrier

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LIBRIS-ID:oai:DiVA.org:ltu-83661
https://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-83661URI
https://doi.org/10.3899/jrheum.201251DOI
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-407859URI
http://kipublications.ki.se/Default.aspx?queryparsed=id:147256072URI

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Language:English
Summary in:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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Validerad;2021;Nivå 2;2021-08-11 (alebob)
ObjectiveTo investigate risk factors and characteristics of active tuberculosis (TB) in biologics-naïve rheumatoid arthritis (RA) patients.MethodsPopulation-based case-control study using the Swedish Rheumatology Quality Register, the National Patient Register and the Tuberculosis Register to identify RA cases with active TB and matched RA controls without TB 2001-2014. Clinical data were obtained from medical records. TB risk was estimated as adjusted (adj) odds ratios (OR) with 95% confidence intervals (CI) using univariate and multivariable logistic regression analyses.ResultsAfter validation of diagnoses, the study included 31 RA cases with TB, and 122 matched RA controls. All except three cases had reactivation of latent TB. Pulmonary TB dominated (84%). Ever use of methotrexate was not associated with increased TB risk (adj OR 0.8; 95% CI 0.3-2.0), whereas ever treatment with leflunomide (adj OR 6.0; 95% CI 1.5-24.6), azathioprine (adj OR 3.8; 95% CI 1.1-13.8) and prednisolone (adj OR 2.4 (95% CI 1.0-5.9) was. There were no significant differences of maximum dose of prednisolone, treatment duration with prednisolone before TB, or cumulative dose of prednisolone the year before TB diagnosis between cases and controls. Obstructive pulmonary disease was associated with an increased TB risk (adj OR 3.9; 95% CI 1.4-10.7).ConclusionSeveral RA-associated factors may contribute to the increased TB risk in biologics-naïve RA patients, making risk of TB activation difficult to predict in the individual patient. To further decrease TB in RA patients, the results suggest that screening for latent TB should also be considered in biologics-naïve patients.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Reumatologi och inflammation hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Rheumatology and Autoimmunity hsv//eng
rheumatoid arthritis
tuberculosis
biologic–naïve
risk factors
Medicinsk vetenskap
Medical Science

Added entries (persons, corporate bodies, meetings, titles ...)

Arkema, Elizabeth V.Karolinska Institutet (author)
Bruchfeld, JudithKarolinska Institutet (author)
Jonsson, JerkerKarolinska Institutet (author)
Askling, JohanClinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Rheumatology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden,Karolinska Inst, Clin Epidemiol Div, Dept Med Solna, Stockholm, Sweden.;Karolinska Inst, Rheumatol Div, Dept Med, Stockholm, Sweden. (author)
Baecklund, Eva,1956-Uppsala universitet,Reumatologi(Swepub:uu)evaba786 (author)
Luleå tekniska universitetHälsa, medicin och rehabilitering (creator_code:org_t)

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In:Journal of Rheumatology: The Journal of Rheumatology Publishing Co. Ltd.48:8, s. 1243-12500315-162X1499-2752

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