血清阳性及改善病情抗风湿药物对类风湿关节炎患者患肺结核风险的影响。

Impact of seropositivity and disease-modifying antirheumatic drugs on pulmonary tuberculosis risk in rheumatoid arthritis.

作者信息

Choi Hayoung, Eun Yeonghee, Han Kyungdo, Jung Jin-Hyung, Jung Wonyoung, Kim Hyungjin, Shin Dong Wook, Lee Hyun

机构信息

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.

H. Choi and Y. Eun contributed equally to this work as co-first authors.

出版信息

ERJ Open Res. 2025 May 27;11(3). doi: 10.1183/23120541.00957-2024. eCollection 2025 May.

DOI:10.1183/23120541.00957-2024

PMID:40432816

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12107382/

Abstract

BACKGROUND

It remains unclear whether active pulmonary tuberculosis risk is still high in rheumatoid arthritis patients in settings where tuberculosis infection screening is performed before the use of biologicals. Moreover, the impacts of seropositivity and disease-modifying antirheumatic drugs on active pulmonary tuberculosis risk should be elucidated.

METHODS

The incidence of active pulmonary tuberculosis was compared between patients with rheumatoid arthritis (n=59 577; 41 501 seropositive rheumatoid arthritis and 18 076 seronegative rheumatoid arthritis) and 1:5 age- and sex-matched controls without rheumatoid arthritis (n=297 885) enrolled between 2010 and 2017. The participants were followed until December 2019.

RESULTS

During a median follow-up duration of 4.4 years after a 1-year lag period (interquartile range 2.6-6.4 years; maximum 9 years), patients with rheumatoid arthritis showed a 3.2-fold (95% CI 2.91-3.55) higher active pulmonary tuberculosis risk than matched controls, even after adjusting for potential confounders. In an analysis of rheumatoid arthritis serological status, patients with seropositive rheumatoid arthritis and those with seronegative rheumatoid arthritis showed 3.20-fold (95% CI 2.86-3.58) and 2.54-fold (95% CI 2.13-3.04) increased risks, respectively, relative to matched controls. Furthermore, rheumatoid arthritis patients who were exposed to biological or targeted synthetic and disease-modifying antirheumatic drugs and those not exposed to the drugs showed 4.68-fold (95% CI 3.69-5.93) and 2.88-fold (95% CI 2.59-3.20) increased risks, respectively, relative to matched controls. In rheumatoid arthritis patients, active pulmonary tuberculosis risk factors included male sex, underweight and comorbidities such as diabetes mellitus.

CONCLUSION

Rheumatoid arthritis patients are prone to active pulmonary tuberculosis development, with rates affected by seropositivity and disease-modifying antirheumatic drugs. Focused tuberculosis screenings may need to be carried out in rheumatoid arthritis patients based on our results.

摘要

背景

在使用生物制剂前进行结核感染筛查的情况下，类风湿关节炎患者发生活动性肺结核的风险是否仍然很高尚不清楚。此外，血清学阳性和改善病情抗风湿药物对活动性肺结核风险的影响也应予以阐明。

方法

比较2010年至2017年期间纳入的类风湿关节炎患者（n = 59577；41501例血清学阳性类风湿关节炎患者和18076例血清学阴性类风湿关节炎患者）与1:5年龄和性别匹配的无类风湿关节炎对照者（n = 297885）的活动性肺结核发病率。对参与者进行随访至2019年12月。

结果

在1年的滞后期后，中位随访时间为4.4年（四分位间距2.6 - 6.4年；最长9年），即使在调整潜在混杂因素后，类风湿关节炎患者发生活动性肺结核的风险仍比匹配对照者高3.2倍（95%CI 2.91 - 3.55）。在对类风湿关节炎血清学状态的分析中，血清学阳性类风湿关节炎患者和血清学阴性类风湿关节炎患者相对于匹配对照者的风险分别增加了3.20倍（95%CI 2.86 - 3.58）和2.54倍（95%CI 2.13 - 3.04）。此外，暴露于生物制剂或靶向合成及改善病情抗风湿药物的类风湿关节炎患者和未暴露于这些药物的患者相对于匹配对照者的风险分别增加了4.68倍（95%CI 3.69 - 5.93）和2.88倍（95%CI 2.59 - 3.20）。在类风湿关节炎患者中，活动性肺结核的危险因素包括男性、体重过轻以及糖尿病等合并症。