RT Journal Article
SR Electronic
T1 Tuberculosis in Biologic-naïve Patients With Rheumatoid Arthritis: Risk Factors and Tuberculosis Characteristics
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.201251
DO 10.3899/jrheum.201251
A1 Johanna Karlsson Sundbaum
A1 Elizabeth V.  Arkema
A1 Judith Bruchfeld
A1 Jerker Jonsson
A1 Johan Askling
A1 Eva Baecklund
YR 2021
UL http://www.jrheum.org/content/early/2021/05/27/jrheum.201251.abstract
AB Objective To investigate risk factors and characteristics of active tuberculosis (TB) in biologic-naïve patients with rheumatoid arthritis (RA). Methods We conducted a population-based case-control study using the Swedish Rheumatology Quality Register, the National Patient Register, and the Tuberculosis Register to identify RA patients with active TB and matched RA controls without TB between 2001–2014. Clinical data were obtained from medical records. TB risk was estimated as adjusted OR (aOR) with 95% CI using univariate and multivariable logistic regression analyses. Results After validation of diagnoses, the study included 31 RA patients with TB and 122 matched RA controls. All except 3 cases had reactivation of latent TB. Pulmonary TB was most prevalent (84%). Ever use of methotrexate was not associated with increased TB risk (aOR 0.8, 95% CI 0.3–2.0), whereas ever treatment with leflunomide (aOR 6.0, 95% CI 1.5–24.7), azathioprine (aOR 3.8, 95% CI 1.1–13.8), and prednisolone (PSL; aOR 2.4, 95% CI 1.0–6.0) was. There were no significant differences between maximum dose of PSL, treatment duration with PSL before TB, or cumulative dose of PSL the year before TB diagnosis between cases and controls. Obstructive pulmonary disease was associated with an increased TB risk (aOR 3.9, 95% CI 1.5–10.7). Conclusion Several RA-associated factors may contribute to increased TB risk in biologic-naïve patients with RA, making the risk of TB activation difficult to predict in the individual patient. To further decrease TB in patients with RA, the results suggest that screening for latent TB should also be considered in biologic-naïve patients.