Risk Factors for Pulmonary Nontuberculous Mycobacterial Disease in Rheumatoid Arthritis Patients

Yoichi Nakayama¹, Eisaku Tanaka ², Masakuni Ueyama ³, Satoru Terada ², Takashi Inao ², Yusuke Kaji ², Takehiro Yasuda ², Seishu Hashimoto ², Takashi Hajiro ² and Yoshio Taguchi ², ¹Tenri Hospital, Department of General Internal Medicine, Tenri, Nara, Japan, ²Tenri Hospital, Department of Respiratory Medicine, Tenri, Nara, Japan, ³Tenri Hospital, Department of Respiratory Medicine, Tenri, Japan

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: ACPA and rheumatoid arthritis (RA), non-tuberculosis mycobacterium

Session Information

Date: Tuesday, November 12, 2019

Title: Infection-Related Rheumatic Disease Poster

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Rheumatoid arthritis (RA) patients have increased susceptibility to infection by pulmonary nontuberculous mycobacterial disease (pNTM) compared with the healthy population. The reason for this increased susceptibility to pNTM in RA patients is still unclear and few studies have been conducted to identify risk factors.

Methods: Medical records for all the RA patients who attended our hospital from March 2017 to March 2018 were retrospectively reviewed. pNTM was diagnosed by the criteria of the American Thoracic Society and the Infectious Diseases Society of America. Clinical factors such as age, gender, BMI, smoking history, diabetes, Charlson Comorbidity Index (CCI), rheumatoid factor (RF), anti-citrullinated protein antibody (ACPA), DMARDs, and chest CT findings were collected and compared between RA patients with and without pNTM.

Results: Data from 868 RA patients (205 males, 663 females) were analyzed. Among those patients, 37 patients were diagnosed with pNTM. Patients with pNTM were significantly older and had lower BMI than those without (72 +/- 10.6 vs 66.9 +/-13.5, p=0.014, and 20.0 +/-3.9 kg/m²vs 22.5 +/-4.5 kg/m², p=0.016, respectively). RF positivity was significantly higher in patients with pNTM (100% vs 83.6%, p=0.014). Percentages of MTX or bDMARDs use were significantly lower in patients with pNTM (48.9% vs 69.0%, p=0.016, 10.8% vs 30.0%, p=0.020). For chest CT findings, consolidation, cavitary lesion, pleural effusion, nodular lesion, and bronchiectasis were significantly higher among patients with pNTM (71.4% vs 8.0%, 14.3% vs 1.1%, 17.1% vs 2.0%, 85.7% vs 16.2%, and 62.9% vs 14.2%, respectively, with all p< 0.001). Multiple logistic regression analysis revealed ACPA and lower BMI to be independent risk factors of pNTM in RA patients (OR=4.9, 95% CI 1.1-21.0 and OR=0.8, 95% CI 0.7-0.9, respectively).

Conclusion: As is consistent with patients without RA, lower BMI is a risk factor for pNTM in RA patients. We identified ACPA positivity as a novel risk factor for pNTM in RA patients.

Disclosure: Y. Nakayama, None; E. Tanaka, None; M. Ueyama, None; S. Terada, None; T. Inao, None; Y. Kaji, None; T. Yasuda, None; S. Hashimoto, None; T. Hajiro, None; Y. Taguchi, None.

To cite this abstract in AMA style:

Nakayama Y, Tanaka E, Ueyama M, Terada S, Inao T, Kaji Y, Yasuda T, Hashimoto S, Hajiro T, Taguchi Y. Risk Factors for Pulmonary Nontuberculous Mycobacterial Disease in Rheumatoid Arthritis Patients [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/risk-factors-for-pulmonary-nontuberculous-mycobacterial-disease-in-rheumatoid-arthritis-patients/. Accessed .

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