Lim Doo-Ho, Kim Yong-Gil, Shim Tae Sun, Jo Kyung-Wook, Ghang Byeongzu, Ahn Soo Min, Hong Seokchan, Lee Chang-Keun, Yoo Bin
Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Intern Med. 2017 Nov;32(6):1090-1097. doi: 10.3904/kjim.2015.357. Epub 2017 Jan 6.
BACKGROUND/AIMS: Nontuberculous mycobacteria (NTM) infection has been increasing worldwide in both general population and immunocompromised patients, which has also been reported in rheumatoid arthritis (RA) patients. This study aimed to identify the incidence and clinical characteristics of NTM infection in RA patients living in tuberculosis (TB) infection endemic area.
We performed a retrospective analysis of NTM infection cases in our RA registry at a tertiary referral center from January 1995 to December 2013. The clinical features of them were compared to those of 52 TB infection patients from same registry.
Among 1,397 patients with RA, NTM infection was newly developed in 26 patients and the incidence of NTM infection was 164.8 per 100,000 patient-years. The Mycobacterium avium complex was the most frequent isolate (76.9%). None of the NTM infections had extrapulmonary involvement, which was rather common in TB infection (26.9%). Patients with NTM infection were older, received higher cumulative steroid doses, and had higher rates of past TB infection history and concomitant interstitial lung disease (ILD) than cases with TB infection.
In South Korea, NTM infection is not rare in RA patients, and infection rates are growing. Physicians should be cautious about NTM infection in patients with a history of TB infection or concomitant ILD, even living in TB endemic area.
背景/目的：非结核分枝杆菌（NTM）感染在全球普通人群和免疫功能低下患者中均呈上升趋势，类风湿关节炎（RA）患者中也有相关报道。本研究旨在确定生活在结核病（TB）感染流行地区的RA患者中NTM感染的发生率及临床特征。
我们对1995年1月至2013年12月在一家三级转诊中心的RA登记处的NTM感染病例进行了回顾性分析。将他们的临床特征与来自同一登记处的52例TB感染患者的特征进行比较。
在1397例RA患者中，26例新发生NTM感染，NTM感染发生率为每10万患者年164.8例。鸟分枝杆菌复合群是最常见的分离株（76.9%）。NTM感染均无肺外受累情况，而这在TB感染中相当常见（26.9%）。与TB感染患者相比，NTM感染患者年龄更大，累积使用类固醇剂量更高，既往TB感染史和合并间质性肺病（ILD）的发生率更高。
在韩国，RA患者中NTM感染并不罕见，且感染率在上升。即使生活在TB流行地区，医生对于有TB感染史或合并ILD的患者的NTM感染也应谨慎。
