Abstract

OBJECTIVE

The objective of this study was to investigate the prevalence of latent tuberculosis (TB) infection (LTBI) and its associated factors in patients with inflammatory rheumatic diseases (IRDs) prior to the administration of biologic and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs/tsDMARDs).

MATERIAL AND METHODS

A total of 402 patients with IRDs who were receiving bDMARDs/tsDMARDs from tertiary rheumatology centers in three different geographical regions were included in the study. Demographic, clinical, and TB-related characteristics were documented. The patients were divided into two groups, namely those with LTBI and non-LTBI, and their data were subjected to comparative analysis. The impact of various factors on LTBI was evaluated by regression analysis.

RESULTS

The prevalence of LTBI was 50.7% (204/402) before bDMARD/tsDMARD therapy. The proportion of male patients [108 (52.9%) vs. 84 (42.3%); P = 0.03] and the prevalence of smoking [102 (50.0%) vs. 64 (32.3%); P = 0.001] were statistically higher in the LTBI group. The preference for adalimumab was statistically lower in patients with LTBI (30.4%, 62/204 vs. 45.9%, 91/198; P = 0.021). Smoking [odds ratio (OR) 95% confidence interval (CI): 1.46 (1.16-1.65); P = 0.007], and duration of bDMARD use [OR 95% CI: 1.10 (1.03-1.17); P = 0.013] were significantly associated with LTBI. Isoniazid was used as the prophylactic agent in 96.45% (190/204) of patients, whereas there were no cases of TB reactivation among the three cohorts.

CONCLUSION

The present study demonstrated that more than half of patients with IRDs undergoing advanced therapies have LTBI, with this infection being associated with male sex, smoking status, and duration of bDMARD use. Furthermore, this study indicates that appropriate screening and treatment of LTBI in patients with rheumatic diseases are associated with favorable clinical outcomes.