High Prevalence of Active Tuberculosis in Adults and Children with Idiopathic Inflammatory Myositis as Compared with Systemic Lupus Erythematosus in a Tuberculosis Endemic Country: Retrospective Data Review from a Tertiary Care Centre in India

Gupta, Latika; Aggarwal, Rohit; Naveen, R; Lawrence, Able; Zanwar, Abhishek; Misra, Durga Prasanna; Agarwal, Vikas; Misra, Ramnath; Aggarwal, Amita

doi:10.31138/mjr.32.2.134

Cited by 5 publications

(3 citation statements)

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“…A study in Indonesia (2022) showed that the incidence of ATB in SLE patients was 2873 cases per 100,000 person years (95% confidence interval [CI], 2400-3345), about 8 times that of the general population (354 per 100,000 population) ( 20 ). A study from India (2021) showed that the incidence of ATB in adult SLE patients was 6.1 per 100 patients, nearly 30 times that of the general population (211 per 100,000 population) ( 28 ); while another study from India in the same year showed that the incidence of ATB in SLE patients was 733 per 100,000 patient years, about 3 times that of the general population ( 18 ). Thus, no matter in high or low TB prevalence areas, the incidence of ATB in SLE patients is higher than that in the general population.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of tuberculosis in systemic lupus erythematosus patients: a multi-center prospective cohort study

Zhang¹,

Zou²,

Jiang³

et al. 2023

Front. Immunol.

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ObjectivesBoth burdens of tuberculosis (TB) and systemic lupus erythematosus (SLE) in China are ranked as top three in the world. SLE patients are at high risk for TB, but so far, there are no guidelines for TB prevention and management targeting this population in China. This study aims to investigate the incidence of active tuberculosis (ATB) and to explore the risk factors for developing ATB in SLE patients, and to provide evidence for TB prevention and management for SLE patients in China.MethodsA multi-center prospective cohort study was conducted. SLE patients were enrolled from clinics and wards of 13 tertiary hospitals in Eastern, Middle, and Western China from September 2014 to March 2016. Baseline demographic features, TB infection status, clinical information, and laboratory data were collected. ATB development was examined during follow-up visits. Kaplan-Meier method was applied to plot survival curves, and Log-rank test was used to evaluate differences. Cox proportional-hazards model was used to explore the risk factors for ATB development.ResultsWith a median follow-up time of 58 months [interquartile range (IQR): 55-62], 16 out of 1361 SLE patients developed ATB. The 1-year incidence of ATB was 368 [95% confidence interval (CI): 46-691] per 100,000. Over a 5-year period, the cumulative incidence of ATB was 1141 [95% CI: 564-1718] per 100,000, and the incidence density was 245 per 100,000 person-years. Cox regression models were constructed with maximum daily dose of glucocorticoids (GCs) as a continuous variable and a categorical variable, respectively. In model 1, maximum daily dose of GCs (pills per day) [adjusted hazard ratio (aHR)=1.16, 95%CI: 1.04-1.30, p=0.010] and TB infection (aHR=8.52, 95%CI: 3.17-22.92, p<0.001) were independent risk factors for ATB development. In model 2, maximum daily dose of GCs≥30 mg/d (aHR =4.81, 95%CI: 1.09-22.21, P=0.038) and TB infection (aHR=8.55, 95%CI: 3.18-23.00, p<0.001] were independent risk factors for ATB development.ConclusionsSLE patients had a higher incidence of ATB compared to the general population. The risk of developing ATB was even higher with increased daily dose of GCs or in a status of TB infection, in which case TB preventive treatment should be considered.

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Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of tuberculosis in systemic lupus erythematosus patients: a multi-center prospective cohort study

Zhang¹,

Zou²,

Jiang³

et al. 2023

Front. Immunol.

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“…In recent years, studies have reported inconsistent results regarding the specific incidence and prevalence of SLE-TB (10)(11)(12)(13). Therefore, a contemporary and comprehensive evaluation and update of the SLE-TB epidemiology data worldwide is necessary as it will provide a theoretical basis for TB screening and preventive treatment in SLE patients.…”

Section: Introductionmentioning

confidence: 99%

Incidence and prevalence of tuberculosis in systemic lupus erythematosus patients: A systematic review and meta-analysis

et al. 2022

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BackgroundSystemic lupus erythematosus (SLE) patients are particularly susceptible to infections, such as pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB). This meta-analysis aimed to determine the incidence and prevalence of tuberculosis (TB) in SLE patients.MethodsThe Web of Science, PubMed, Cochrane Library, and Chinese National Knowledge Infrastructure databases were searched for articles of relevant studies published from the dates the databases were established until April 30, 2022. The I2 statistic and Q test were used to evaluate heterogeneity among the analysed studies. Random-effects models were utilised and subgroup analyses were conducted for analysis of the study data.ResultsA total of 35 studies with 46,327 SLE patients were eligible for analysis. The incidence and prevalence of TB among the SLE patients were 1.16 per 100 person-years (95% confidence interval (CI): 0.69-1.93) and 3.59% (95% CI: 2.57%-5.02%), respectively. The pooled prevalence of SLE-PTB and SLE-EPTB was 2.46% (95% CI: 1.73%-3.51%) and 1.42% (95% CI: 0.98%-2.06%), respectively. Subgroup analyses showed that the incidence of SLE-TB was higher in Africa and in countries with a high TB burden than in countries with a low TB burden. The prevalence of SLE-TB was elevated in Asia, in patients taking a mean daily dose of glucocorticoids ≥20 mg, in studies with small sample sizes (n <1000) and ended before 2001.ConclusionsThe available evidence suggests that both the incidence and prevalence of TB in SLE patients are high. This study provides a more specific understanding of SLE-TB, which can help health policymakers in the development of preventive strategies for reducing the SLE-TB burden.

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“…7 We observed a considerable number of patients with infections particularly tuberculosis, which is fairly common in IIM, particularly in endemic regions, as described previously. 8,9,12 This underscores the necessity of considering infectious screening, particularly tuberculosis and management of these comorbidities as essential components of patient care. Furthermore, we observed a significant occurrence of thyroid disease in patients who had CAM.…”

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Comorbidities in idiopathic inflammatory myopathies: Data from the MyoCite cohort

Conticini,

Khursheed,

Anuja

et al. 2023

Int J of Rheum Dis

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Idiopathic inflammatory myopathies (IIMs) are a group of heterogeneous and rare disorders affecting multisystems in addition to muscles, often leading to substantial impairment in quality of life. 1 Ethnic and geographic variations influence the autoantibody patterns and clinical spectrum among IIM patients. 2 Patients affected by IIM may suffer from several comorbidities, such as cancer or cardiovascular disease, which may complicate the course of the disease. Certain comorbidities are associated with worse outcomes and increased mortality. 3 Moreover, the presence of comorbidities may impact treatment choices.Previous studies have highlighted an elevated risk of coexisting malignancy 4,5 and cardiovascular disease 6 in the literature. However, the exact prevalence of other comorbidities and their correlation with autoantibodies remains largely unexplored. Our primary objective was to investigate the spectrum of comorbidities among Indian patients diagnosed with IIM in a tertiary care center, to establish the MyoCite Cohort, and to evaluate their potential associations with disease subtypes and antibodies.The MyoCite dataset represents a repository of longitudinal data, encompassing adults and children diagnosed with IIM who received or are currently receiving treatment at a tertiary care hospital in India. A comprehensive account of the methodology has been previously published, incorporating details on patient selection and definitions of disease subsets. 7,8 Through a thorough screening process, both adults and children presenting with myositis were meticulously evaluated. 9 From the MyoCite dataset, we extracted essential demographic information, such as age, gender, disease subtypes, comorbidities, and autoantibodies, to facilitate our investigation.Comorbidities were classified as autoimmune, cardiovascular, cancer, infections, and others. In addition, autoantibodies were classified into myositis-specific antibodies (MSAs), myositis-associated antibodies (MAAs), anti-aminoacyl tRNA synthetase antibodies (ARAs), and anti-nuclear antibodies (ANAs) as well as individual

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High Prevalence of Active Tuberculosis in Adults and Children with Idiopathic Inflammatory Myositis as Compared with Systemic Lupus Erythematosus in a Tuberculosis Endemic Country: Retrospective Data Review from a Tertiary Care Centre in India

Cited by 5 publications

References 30 publications

Incidence and risk factors of tuberculosis in systemic lupus erythematosus patients: a multi-center prospective cohort study

Incidence and risk factors of tuberculosis in systemic lupus erythematosus patients: a multi-center prospective cohort study

Incidence and prevalence of tuberculosis in systemic lupus erythematosus patients: A systematic review and meta-analysis

Comorbidities in idiopathic inflammatory myopathies: Data from the MyoCite cohort

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