Risk of tuberculosis in patients with spondyloarthritis: data from a centralized electronic database in Hong Kong
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(2020) 21:832
RESEARCH ARTICLE
Open Access
Risk of tuberculosis in patients with spondyloarthritis: data from a centralized electronic database in Hong Kong Natalia Chu-Oi Ciang1, Shirley Chiu Wai Chan2, Chak Sing Lau2, Eva Tsz Fung Chiu2 and Ho Yin Chung2*
Abstract Background/ objective: Tuberculosis (TB) is one of the most infectious comorbidities in spondyloarthritis (SpA). Our goals were to determine the crude incidence rate of and risk factors for TB in SpA. Method: Clinical data of 2984 patients with SpA from 11 rheumatology centres were reviewed. This included demographics, duration of follow-up, comorbidities including diabetes, chronic kidney disease, chronic heart disease, chronic lung disease, stroke and malignancies, date of diagnosis of tuberculosis, use of non-steroidal antiinflammatory drugs, duration of glucocorticoid therapy for more than 6 months, conventional (cDMARD) and biological (bDMARD) disease modifying anti-rheumatic drug therapies. Crude incidence rates were reported. Cox regression models were used to determine the risk factors for TB in patients with SpA. Results: Forty-three patients had TB, of which 4 (9.3%) were extra-pulmonary. The crude incidence rate of TB was 1.57 in patients with SpA, compared with 0.58 in the general population in Hong Kong. Independent risk factors identified from the multivariate Cox regression model were: alcohol use (HR 2.62; p = 0.03), previous TB (HR 13.62; p < 0.001), chronic lung disease (HR 3.39; p = 0.004), duration of glucocorticoid therapy greater than 6 months (HR 3.25; p = 0.01) and infliximab therapy (HR 5.06; p < 0.001). Age was associated with decreased risk (HR 0.93; p < 0.001). Conclusion: Incidence of TB was higher in patients with SpA. Glucocorticoid therapy beyond 6 months and infliximab therapy increased the risk of TB. Rheumatologists should avoid prolonged use of glucocorticoids and consider DMAR Ds other than infliximab in the treatment of at-risk patients. Keywords: Spondyloarthritis, Tuberculosis, Disease modifying anti-rheumatic drugs, Glucocorticoid, Infliximab
Introduction Spondyloarthritis (SpA) is a spectrum of inflammatory rheumatic diseases comprised of ankylosing spondylitis (AS), psoriatic arthritis (PsA), enteropathic arthritis associated with inflammatory bowel disease (IBD), reactive arthritis, undifferentiated spondyloarthritis (uSpA) and human leucocyte antigen B27 (HLA-B27) associated * Correspondence: [email protected] 2 Division of Rheumatology and Clinical Immunology, The University of Hong Kong, Hong Kong, Hong Kong Full list of author information is available at the end of the article
uveitis. SpA leads to impairments in quality of life, work, leisure and daily activity [1], and is associated with many comorbidities including infection [2]. Tuberculosis (TB) is one of the most important infectious comorbidities in SpA. TB leads the global burden of morbidity and mortality, causing 1.4 million deaths annually, with the majority in Africa and Asia [3]. Previous studies have shown increased rates of TB
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