Rheumatic diseases and latent tuberculosis infection in children: diagnostic and therapeutic challenges

Latent tuberculosis infection (LTBI) is a state of sustained immune response to Mycobacterium tuberculosis (MTB) antigens, without clinical evidence of active tuberculosis. Rheumatic diseases, a common type of autoimmune disease, are often treated with glucocorticoids, immunosuppressants, biologics, and small-molecule targeted drugs. These medications can cause immune dysfunction in patients, increasing the risk of latent tuberculosis reactivation. Children with rheumatic diseases are particularly susceptible to MTB due to their immature immune systems, the nature of their rheumatic disease, and the use of anti-rheumatic medications. This susceptibility makes LTBI more likely to progress to active tuberculosis. Therefore, it is crucial to prioritize LTBI screening in children with rheumatic diseases, identify LTBI promptly, and initiate preventive antituberculosis treatment to prevent the onset of active tuberculosis and ensure the health of children with rheumatic diseases. This article discusses the susceptibility mechanisms, diagnostic methods, and preventive antituberculosis treatment strategies for children with rheumatic diseases and LTBI, aiming to reduce the risk of progression to active tuberculosis and improve patient outcomes.