Cigarette smoking, TB, and TNF inhibitors

Bieber, Jeffry D

doi:10.1136/ard.62.11.1118

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…Unfortunately, we could not capture other factors associated with the risk of TB disease while being exposed to RA drugs, including country of birth, Aboriginal race/ethnicity, socioeconomic status, a history of recent contact with an individual with TB, and the presence of TB-associated abnormal findings on a chest radiograph (13). Information on human immunodeficiency virus infection status or smoking behavior was also lacking (17,18). If at-risk groups were overrepresented in our cohort, it may explain the higher than previously reported observed risk of TB.…”

Section: Discussionmentioning

confidence: 46%

Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada

Brassard

Lowe

Bernatsky

et al. 2009

Arthritis & Rheumatism

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Objective. To determine the risk of tuberculosis (TB) among a cohort of patients with rheumatoid arthritis (RA) in Quebec and assess whether this risk is associated with exposure to nonbiologic disease-modifying antirheumatic drugs (DMARDs). Methods. We studied a cohort of patients with RA identified from the Quebec provincial physician billing and hospitalization databases for 1980 -2003. TB incidence rates were determined for the period 1992-2003 and compared with the general population, standardized for age and sex using the standardized incidence ratio (SIR). Conditional logistic regression was used in a nested case-control analysis to estimate the rate ratio (RR) of TB related to nonbiologic DMARD exposure during the year before the index date. Results. Of the 24,282 patients with RA in the cohort, 50 cases of TB were identified. The standardized incidence rate was 45.8 cases per 100,000 person-years compared with 4.2 cases per 100,000 person-years in the general population of Quebec (SIR 10.9, 95% confidence interval [95% CI] 7.9 -15.0). The adjusted RR of TB was 2.4 (95% CI 1.1-5.4) with corticosteroid use and 3.0 (95% CI 1.6 -5.8) with nonbiologic DMARD use. Conclusion. The age-and sex-standardized incidence rate of TB in RA patients is 10 times that of the general population. At least some of this risk may be related to nonbiologic DMARD and corticosteroid therapies. Our data support the role of TB screening before initiation of any immunosuppressive therapy.

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Section: Discussionmentioning

confidence: 46%

Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada

Brassard

Lowe

Bernatsky

et al. 2009

Arthritis & Rheumatism

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“…Of interest, patients with parenchymal TB, known to be associated with a higher bacillus concentration, were more likely to be heavy smokers than patients with isolated pleural TB, which is associated with a lower bacillus concentration. The following hypothesis may explain the association between TB and smoking: the nicotine in cigarettes may inhibit tumor necrosis factor‐α release by binding to acetylcholine receptors on macrophages or, because cigarettes contain high levels of iron, the function of alveolar macrophages is impaired because of iron deposition 25,26 . Thus, it is likely that smokers have macrophages that are not capable of killing or inhibiting bacilli, resulting in a logarithmic increase in the bacillus concentration.…”

Section: Discussionmentioning

confidence: 99%

“…The following hypothesis may explain the association between TB and smoking: the nicotine in cigarettes may inhibit tumor necrosis factor-a release by binding to acetylcholine receptors on macrophages or, because cigarettes contain high levels of iron, the function of alveolar macrophages is impaired because of iron deposition. 25,26 Thus, it is likely that smokers have macrophages that are not capable of killing or inhibiting bacilli, resulting in a logarithmic increase in the bacillus concentration. Consequently, following primary infection, the disease progresses, with infiltrations and cavities containing high concentrations of bacillus being observed.…”

Section: Discussionmentioning

confidence: 99%

Mild and severe forms of tuberculosis in diabetic and non‐diabetic patients

Öcal

Saka

Öğretensoy

2009

Journal of Diabetes

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Background: The aim of the present study was to compare the frequency of pleural tuberculosis in patients with and without diabetes mellitus (DM). Methods: Three hundred consecutive patients who were smear positive for pulmonary tuberculosis or isolated pleural tuberculosis were enrolled in the study. Patients’ age and smoking status (pack‐years) were recorded. Patients were divided into two groups: those with and without DM. Results: All patients enrolled in the study were male. Mean (±SD) patient age was 42.4 ± 15.9 years. Of the 300 patients in the study, 48 had DM. There was no significant difference in the distribution of pulmonary tuberculosis and isolated pleural tuberculosis between patients with and without DM (P > 0.05). However, there was a significant difference in mean pack‐years of smoking between patients with pulmonary tuberculosis and those with isolated pleural tuberculosis for all patients; patients with isolated pleural tuberculosis had a significantly lower number of pack‐years of smoking (P < 0.05). Conclusion: Severe pulmonary involvement in DM patients may be due to smoking status.

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“…Nicotine is a potent stimulator of this receptor. Cigarette smoking may increase susceptibility to TB; this may be relevant to patients who are treated with TNF inhibitors [26].…”

Section: Immune Defense Against Tuberculosismentioning

confidence: 99%