Background Patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) have an increased risk of developing tuberculosis (TB), which is possibly related to the disease itself, as well as to the treatment with immunosuppressive drugs. Several studies investigated this risk; however, they usually include patients with established disease and patients who received long-term treatment.
Objectives To investigate the association between history of TB and early RA (ERA) and early axial SpA (ESpA) in 2 French cohorts, ESPOIR (1) and DESIR (2), at onset of the disease.
Methods Baseline data of 689 ESPOIR patients (age 48.2±12.1 years, symptom duration 14.2±14.5 weeks) and 645 DESIR patients (age 32.8±8.4 years, axial symptom duration 79.0±45.7 weeks) were analyzed. The frequency of history of TB was determined in each cohort. The prevalence (95% confidence intervals (95% CI)) of history of TB was compared to the age and gender adjusted prevalence in the French general population (data gathered from the statistic reports of the French National Health Insurance Fund for the Employees, including almost 90% of the total French population).
Results 4.6% of ERA patients and 0.9% of ESpA had a history of TB. The prevalence (95% CI) of TB history was significantly higher in ESPOIR and DESIR than in the general population (4.7% (3.3%>6.6%) and 1.0% (0.4%>2.3%), vs. 0.02%) after adjustment for age and gender. The increase was more accentuated in women for both cohorts.
Conclusions We found an increased frequency of history of TB in ERA and ESpA even after short symptom duration, and before treatment start. These data are based on self-declaration of patients and should be checked, but are in line with the increased frequency of positivity of Quantiferon in the RA population. These results should prompt rheumatologists to check for tuberculosis already early in disease.
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Acknowledgements AMG was supported by a EULAR scientific training bursary for 6 months.
Disclosure of Interest None declared