Latent and Manifest Tuberculosis in Patients with Rheumatoid Arthritis Treated with Anticytokine Therapy

Abstract Objectives The aim of study was to determine the occurrence and risk factors of latent (LTBI) and manifest tuberculosis infection (MTBI) in patients with rheumatoid arthritis (RA) treated with biologic and targeted-synthetic disease-modifying drugs (b/tsDMARDs) in Slovakia. Methods Retrospective observational study included 689 patients with moderate-to-severe RA treated with b/ts DMARDS, screened for LTBI. Results The prevalence of of LTBI before the initiation of b/tsDMARDs was 10.3%. During subsequent treatment with b/tsDMARD, LTBI was diagnosed in another 12% of remaining patients (17,9 cases/1000 patient-years of treatment). Patients diagnosed with LTBI were older (64.2 ± 12.4 vs 60.9 ± 12.8, p = 0.02), more often treated with TNF inhibitors (p = 0.032), and had a longer duration of bDMARD/tsDMARD therapy (83.7 ± 44.1 versus 49.2 ± 40.2 months, p < 0.001). As many as 73 of 74 patients with LTBI were treated with the first bDMARD/tsDMARD (p < 0.001). Risk factors associated with LTBI were first bDMARD/tsDMARD (OR = 32.5 (95% CI: 6.3–609.6), p = 0.001) and duration of anticytokine treatment (OR 1.013 (CI: 1.007–1.019), p < 0.001). MTBI was diagnosed with an incidence of 0.3% (2 of 689 patients). The proportion of tuberculosis manifestation in previously diagnosed LTBI cases was 1.4%. Conclusion LTBI can affect up to 21% of RA patients treated by b/tsDMARDs. Treatment with the initial bDMARD, TNF inhibition, and the duration of anticytokine therapy have been identified as risk factors for LTBI occurence. The incidence of MTBI is 1.4%, which demonstrates the high effectiveness of chemoprophylaxis in preventing the activation of tuberculosis.