Background More than 80% of cases of tuberculosis are the result of reactivated latent infection, and nearly all these cases could be prevented by the administration of a course of antibiotic treatment. Therefore, it is suggested screening and treatment are most beneficial for those patients taking immunosuppressive medications. Although the prevalence of latent tuberculosis infection in China was much higher than the United States on the basis of tuberculin skin testing, In China, so far, no study has been done about prophylactic treatment on prevention of tuberculosis activation during glucocorticoid therapy in patients with rheumatic diseases. Should it been recommended that all patients with rheumatic diseases be screened for the presence of active tuberculosis or LTBI before the use of long term glucocorticoid or immunosuppressive medications in China? It is reported only about 5% of immunocompetent persons with a positive test will have progression from latent infection to disease in their lifetime. and decisions about whether to treat latent tuberculosis should take into account the individual patient's risk for the development of active tuberculosis and the risks of therapy.
Objectives To evaluate the risk of reactivation of LTBI in patients with rheumatic diseases who were undergoing prednisone use and the efficacy and safety of prophylactic treatment on prevention of tuberculosis reactivation.
Methods 1000 patients with rheumatic diseases who were treated with prednisone were enrolled since 2012. IGRA test (the T-SPOT.TB test) were performed for all subjects. 50 patients with a IGRA-positive were administrated with rifampin for 4 months. 2-years follow-up was conducted to evaluate the risk factors of reactivation of LTBI and the efficacy and safety of rifampin treatment on prevention of tuberculosis reactivation.
Results the IGRA-positive rates were 20.6% (206/1000). Forty-eight patients with a IGRA-positive finished the treatment with rifampin for 4 months. 2-years follow-up shows no latent tuberculosis developed into active tuberculosis in the patients with prevention of rifampin, while 3 (0.38%) patients with negative IGRA and 22 (10.7%) patients with positive IGRA without rifampin treatment developed into active tuberculosis. 25 patients had active tuberculosis disease in two years, which 24 patients with SLE and one patient with systemic vasculitis while 20 cases had pulmonary tuberculosis, 3 cases had vertebral tuberculosis and tuberculous peritonitis, tuberculous meningitis was 1 case, respectively. Univariate analysis showed that age, entities of rheumatic disease, dosage of glucocorticoid, DMARDs using, comorbidity with interstitial lung disease and cancer were significantly associated with tuberculosis activation (P<0.05), with the ORs of 0.959, 0.592, 4.45, 0.226, A3.51 and 69.9, respectively. Entities of rheumatic diseases, Dosage of glucocorticoid, DMARDs using, comorbidity of cancer entered the final multivariate Logistic model. No severe adverse effects occurred in all subjects.
Conclusions Medium or high dosage of glucocorticoid treatment appears to increase the risk of activation of latent tuberculosis infection. Latent tuberculosis activation could be safely prevented by 4-months rifampin treatment while starting glucocorticoid and DMARDs therapy.
Disclosure of Interest None declared