[Preventive therapy for iatrogenic active tuberculosis in systemic lupus erythematosus patients]

To explore the efficacy and safety of preventive therapy for iatrogenic active tuberculosis (TB) induced by glucocorticoid.

During 2007-2011, a total of 203 systemic lupus erythematosus (SLE) patients with high-risk active TB, such as a history of TB infection, TB family member and strong positive purified protein derivative (PPD) skin test or hypoalbuminemia and hyperglycemia were enrolled. They were randomly divided into three groups based on whether or not anti-TB treatment was offered at the beginning of glucocorticoid treatment for SLE: simple glucocorticoid group (n = 70); glucocorticoid plus rimifon group (n = 67); glucocorticoid plus rimifon plus ethambutol group (n = 66). Anti-TB treatment was offered at least 12 months for the preventive anti-TB group. And follow-ups were conducted every 2-3 months for 2 year to observe the efficacy and side effects of anti-TB drugs. During this period, anyone with fever and/or cough consulted a physician immediately.

No active TB occurred in anti-TB treatment group. And 8 patients (11.43%) had active TB in simple glucocorticoid group, including hematogenous disseminated TB (n = 1), pulmonary TB (n = 3), bone TB (n = 1), tuberculous meningitis (n = 1) and undefined focus TB infection (n = 2). And 6/8 cases had active TB within 6 months after using glucocorticoids. According to the study protocol, any case of active TB shall receive 3-4 combined anti-TB drugs for 1 year. The TB conditions of 7/8 patients were better controlled by anti-TB treatment.One patient died of tuberculous meningitis after lost follow-up. Two patients had mild temporary numbness in finger tap of both hands. And 3 patients on double anti-TB drugs showed a mild elevation of liver enzymes.

For high-risk population of active TB, glucocorticoid therapy plus 1 or 2 preventive anti-TB treatment drugs may prevent its occurrence. And there is no serious adverse reaction during preventive anti-TB treatment.