High risk of tuberculosis in systemic lupus erythematosus?

Abstract

The incidence and severity of tuberculosis (TB) in patients with systemic lupus erythematosus (SLE) varies greatly among different series. In addition, prospective data are scarce. The aim of this study is to analyse the frequency and severity of TB in our cohort of lupus patients. We analysed data from a prospective database of a single center cohort of 232 patients with SLE (ACR criteria). Prophylaxis with isoniazid was not regularly administered. We identified all cases of TB diagnosed during 10 years (January 1994 to December 2003). The following variables were analysed: annual incidence of TB, location of infection and response to therapy. Data from published series reporting on the incidence of TB among SLE patients were extracted. Three patients (1.3%) suffered clinically manifest TB in 1603 patient-years of follow-up, resulting in an incidence of 187 cases/100,000 patient-years (95% CI 39-547). The pooled annual incidence of TB infection in our area during this period was 30/100,000 individuals. We recorded two cases of pulmonary TB and one case of tuberculous pleurisy. All patients had good response to therapy. The annual incidence of TB among SLE patients in other series, most of them from developing countries, varied between 150/100,000 patients in Turkey and 2450/100,000 patients in India. Of note, high prevalence of extrapulmonary forms as well as elevated TB-associated mortality was reported in most series. TB was more frequent in SLE patients than expected in the general population. We did not see any cases of disseminated infection and all patients had good response to treatment. Our data compare favourably in terms of incidence, severity and outcome with those from highly endemic areas.

Can Lupus Flares be Associated with Tuberculosis Infection?

“…All the studies reported a significant percentage of extrapulmonary TB, up to 66% in a Hong Kong cohort of 526 SLE patients [17]. The mean duration of SLE up to the development of TB was 4.6 years, although it varied from 2 months to 20 years [14][15][16][17][18][19][20][21][22]. Almost all the series reported cases of documented TB before SLE was diagnosed [17,20,21].…”

“…More recently, several studies conducted in different countries have also documented an increased susceptibility for TB among SLE patients, especially in the Far East, where TB is endemic [13][14][15][16][17][18][19][20][21][22]. The incidence of TB in these studies varied from 150 to 2,450/100,000 patient-years (among Turkish and Indian SLE patients respectively).…”

“…In most cases pulmonary TB presented as fever and cough, while extra-pulmonary TB included arthralgia, skin nodules, and weight loss. The interval between TB onset and diagnosis varied from 1 month up to 1 year [14][15][16][17][18]. Compatible with the notion that immunosuppressive therapy increases the susceptibility for TB, several studies have demonstrated a higher cumulative dose and/or a higher mean daily dose of prednisone before TB infection [14,17,20,21].…”

Disseminated tuberculosis masquerading as a presentation of systemic lupus erythematosus

“…16,17 Patients with SLE, especially in TB endemic regions, are susceptible to higher incidence and severity of TB (i.e., increased risk of disseminated disease). 17,18 Moreover, TB infection may be implicated in SLE induction and exacerbation as evidenced by the higher prevalence of antecedent TB infection among SLE patients. 19,20 Clinically, TB and SLE may have similar manifestations such as fever, malaise, weight loss and other overlapping pulmonary and neurological presentations.…”

Comorbid infections in patients with systemic lupus erythematosus: State-of-the-art

“…Так, в Индии и странах Юго-Восточной Азии встречаемость туберку-леза при СКВ в 7-10 раз превосходит таковую в популя-ции и достигает внушительных значений (табл. 2) [54].…”