A study of clinical characteristics of tuberculosis in patients with different types of rheumatic diseases

doi:10.19871/j.cnki.xfcrbzz.2021.02.006

Abstract

Abstract: Objective To investigate the clinical characteristics of tuberculosis in patients with different rheumatic diseases, and to provide reference for clinical diagnosis and treatment. Methods Medical records for 220 tuberculosis patients with different rheumatic diseases and 95 ordinary tuberculosis patients in the Third People's Hospital of Shenzhen from January 2012 to December 2018 were retrieved. Clinical characteristics between patients of different rheumatic diseases and patients were described. Results Among 220 patients with rheumatic diseases and tuberculosis, there were 29.10% (64/220) tuberculosis patients with systemic lupus erythematosus (SLE); 35.91% (79/220) with rheumatoid arthritis (RA); 15.91%(35/220) with ankylosing spondylitis（AS）; 10.00% (22/220) with sicca syndrome (SS); 5.45% (12/220) with of psoriasis; 3.63% (8/220) with dermatomyositis (DM). In terms of gender distribution, most patients with SLE or SS or DM were female while most patients with AS and psoriasis were male. In terms of age distribution, most patients with SLE were young adults while most patients with RA,SS and PSO were middle-aged and elderly (P<0.0033). In the detection of pathogens, the positive rate of TB-DNA was only statistically different between AS and DM (P<0.0033), and there was a statistical difference of acid-fast bacilli smear positive rate between RA and AS (P<0.0033). Compared to ordinary tuberculosis patients, there were statistical differences in sex, age, tuberculosis type, initial treatment or re-treatment, the positive rate of interferon-gamma release assays, GeneXpert, TB-DNA and mycobacterium culture (P<0.05). Conclusions Tuberculosis patients with SLE, SS and DM are mainly female, while with RA, AS and psoriasis are mainly male; Comparing to ordinary tuberculosis patients, patients with rheumatic diseases have lower positive rate of interferon-gamma release test and lower positive rate of pathogen.

Key words: Rheumatic immune diseases, Diagnosis, Complication, Tuberculosis, Gamma interferon release test, Positive rate of pathogen

Chen Tao, Zhang Peize, Fu Liang, Chen Junlian, Zheng Junfeng, Deng Guofang. A study of clinical characteristics of tuberculosis in patients with different types of rheumatic diseases[J]. Electronic Journal of Emerging Infectious Diseases, 2021, 6(2): 101-104.

References

[1] 邓国防,王玉香,陈涛,等. 风湿免疫性疾病并发结核感染的临床特征分析[J]. 中国防痨杂志,2018,40(4):390-394.
[2] RUAN Q, ZHANG S, AI J, et al.Screening of latent tuberculosis infection by interferon-γ release assays in rheumatic patients: a systemic review and meta-analysis[J]. Clinical Rheumatology, 2016, 35(2):417-425.
[3] GARZIERA G, MORSCH ALB, OTESBELGUE F, et al.Latent tuberculosis infection and tuberculosis in patients with rheumatic diseases treated with anti-tumor necrosis factor agents[J]. Clinical Rheumatology, 2017, 36(8):1891-1896.
[4] 刘涌,朱元珏,高金明. 结缔组织病合并结核92例临床分析[J]. 北京医学, 2009, 31(06):328-331.
[5] 刘琳,王仲元,张韬,等. 原发性干燥综合征合并结核病28例临床分析[J]. 中国防痨杂志, 2012, 34(6):384-388.
[6] HOCHBERG MC.Updating the American College of Rheumatology revised criteria for the classification systemic lupus erythematosus[J]. Arthritis Rheum, 1997,40(9):1725.
[7] BOHAN A, PETER JB.Polymyositis and dermatomyositis[J]. N Engl J Med, 1975, 292(8):344-347.
[8] LINDEN SM,VALKENBURG HA,CATS A.Evaluation of diagnostic criteria for ankylosing spondylitis: A proposal for modification of the New York criteria[J]. Arthritis Rheum, 1985, 28(4):357.
[9] SHIBOSKI SC, SHIBOSKI CH,CRISWELL IA, et al.American College of Rheumatology classification criteria for SjÖgren’s Syndrome: A Data Driven Expert consensus Approach in SjÖgren’s International Collaborative Clinic Alliance cohort[J]. Arthritis Care Res(Hoboken), 2012, 64(4):475-487.
[10] ARNETT FC, EDWORTHY SM, BLOCH DA.The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis[J]. Arthritis Rheum, 1988, 31:315-324.
[11] 中华人民共和国国家卫生和计划生育委员会. 肺结核诊断标准(WS 288—2017)[J/CD]. 新发传染病电子杂志, 2018, 3(1): 65-67.
[12] 邓国防, 付亮. 浅谈风湿免疫性疾病并发结核感染的诊治现状[J]. 结核病与肺部健康杂志, 2018, 7(2): 88-90.
[13] 左晓霞. 结缔组织疾病患者结核感染的研究现状与思考[J]. 中华风湿病学杂志, 2009, 13(10): 657-659.
[14] 唐果. 常见风湿病合并结核感染的临床特点及相关因素分析[D]. 贵州:遵义医科大学, 2019.
[15] 依那西普治疗类风湿关节炎和强直性脊柱炎专家组. 依那西普治疗类风湿关节炎和强直性脊柱炎的专家建议(2013)[J].中华医学杂志, 2013, 93(18):29-32.
[16] WHO. Global tuberculosis report 2019[M]. Geneva: World Health Organization, 2019.
[17] YOUSSEF J, NOVOSAD SA, WINTHROP KL.Infection Risk and Safety of Corticosteroid Use[J]. Rheum DisClin North Am 2016, 42(1):157-176.
[18] SARTORI NS, PICON P, PAPKE A, et al.A population-based study of tuberculosis incidence among rheumatic disease patients under anti-TNF treatment[J]. PloS One, 2019, 14(12):e0224963.
[19] DOAN TN, EISEN DP, ROSE MT, et al.Interferon-gamma release assay for the diagnosis of latent tuberculosis infection: A latent-class analysis[J]. PloS One, 2017, 12(11):e0188631.