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Risk of Tuberculosis in Children with Juvenile Idiopathic Arthritis: A Nationwide Population-Based Study in Taiwan

Yi-Chen Hsin1, Lai-Zhen Zhuang2, Kuo-Wei Yeh1

  • 1Department of Pediatric Allergy Immunology and Rheumatology, Division of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

Plos One
|June 6, 2015
PubMed

Insights

Children with juvenile idiopathic arthritis (JIA) in Taiwan face double the risk of tuberculosis (TB). Methotrexate use without TNF inhibitors significantly elevates this risk, highlighting the need for vigilant TB screening in these young patients.

Area of Science:

  • Rheumatology
  • Pediatrics
  • Infectious Diseases

Background:

  • Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease affecting children.
  • The risk of developing tuberculosis (TB) in children with JIA, particularly in endemic regions like Taiwan, requires thorough investigation.
  • Understanding the impact of JIA treatments on TB risk is crucial for patient management.

Purpose of the Study:

  • To determine the risk of tuberculosis (TB) in children diagnosed with juvenile idiopathic arthritis (JIA) in Taiwan.
  • To compare TB incidence between children with JIA and their healthy peers.
  • To assess the influence of specific JIA medications, methotrexate (MTX) and tumor necrosis factor (TNF) inhibitors, on TB risk.

Main Methods:

  • A nested case-control study was conducted using Taiwan's National Health Insurance Research Database (NHIRD).
  • A cohort of children with JIA was identified and matched with non-JIA children.
  • Cox proportional regression models were employed to calculate adjusted hazard ratios (aHRs) for TB risk.

Main Results:

  • The study included 1495 children with JIA and 11592 non-JIA children.
  • Children with JIA exhibited a two-fold higher overall rate of tuberculosis infection compared to non-JIA children.
  • JIA patients using methotrexate (MTX) without tumor necrosis factor (TNF) inhibitors showed a significantly increased TB infection rate (aHR = 4.67).

Conclusions:

  • Children with JIA in Taiwan have a substantially higher risk of developing tuberculosis.
  • The use of methotrexate (MTX) as a monotherapy in JIA patients is associated with an elevated risk of TB.
  • JIA patients receiving TNF inhibitors or no immunosuppressive therapy did not show an increased TB risk compared to the general pediatric population.
Abstract

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