[Tuberculosis risk among patients with systemic diseases].

Area of Science:

• Rheumatology
• Infectious Diseases
• Immunology

Background:

• Patients with systemic rheumatic diseases exhibit a substantially elevated incidence of tuberculosis compared to the general population, with risks amplified 5-15 fold in systemic lupus erythematosus (SLE) patients.
• Reactivation of latent tuberculosis is common, often occurring shortly after the diagnosis of a systemic rheumatic disease.
• Immunosuppression from the underlying disease, glucocorticoids, and therapies like TNF antagonists contribute to increased tuberculosis risk.

Purpose of the Study:

• To highlight the increased risk of tuberculosis in patients with systemic rheumatic diseases.
• To emphasize the importance of screening and preventive measures, particularly before initiating TNF antagonist therapy.
• To discuss the role of immunosuppressive therapies in the context of tuberculosis risk.

Main Methods:

• Recommended tuberculosis screening before anti-TNF therapy includes medical history, chest X-ray, and tuberculin skin test.
• Evaluation of immunological methods for tuberculosis detection in this patient group is ongoing.
• Implementation of specific tuberculosis chemoprophylaxis prior to TNF antagonist initiation.

Main Results:

• Tuberculosis in these patients often presents as extrapulmonary or disseminated disease.
• Prophylactic tuberculosis chemoprophylaxis, initiated at least 3 weeks before TNF antagonists, has successfully reduced tuberculosis incidence in European and North American cohorts.
• Screening strategies for tuberculosis should be considered for all patients with systemic rheumatic diseases on glucocorticoids and/or immunosuppressive therapy.

Conclusions:

• Systemic rheumatic disease patients are at high risk for tuberculosis, necessitating proactive screening and management.
• Pre-treatment screening and chemoprophylaxis are effective in mitigating tuberculosis risk associated with TNF antagonist therapy.
• Expanded tuberculosis screening protocols are warranted for patients with systemic rheumatic diseases receiving immunosuppressive treatments.