Background/Purpose: Patients with rheumatoid arthritis (RA) are known to have an increased risk of tuberculosis, particularly in association with the use of biologic disease-modifying anti-rheumatic drugs (bDMARD) including tumor necrosis factor-α (TNF-α) inhibitors. Korea is a country with a intermediate risk of tuberculosis, and large-scale studies on the risk of tuberculosis in patients with RA in Korea are still lacking. Our study aimed to identify the risk of tuberculosis in patients with RA compared to the general population in a large population-based cohort, and to identify factors associated with the risk of tuberculosis in patients with RA.

Methods: Among patients diagnosed with RA between 2010 and 2017, patients who had undergone a national health examination within two years prior to RA diagnosis were included in the study (n = 59,577). Control group included age- and sex-matched non-RA controls who received a health check-up at the same time as RA patients (n = 297,885). The primary outcome of the study was incident tuberculosis, which was defined by an ICD-10 code and enrollment in the rare intractable disease program. Kaplan-Meier curves and Cox proportional hazards regression analysis were used for the analysis

Results: During a mean follow-up period of 4.5 ± 2.2 years, 979 subjects in the control group and 619 patients in the RA group developed tuberculosis. Patients with RA had a 3-fold higher risk of tuberculosis than age- and sex-matched non-RA controls (adjusted hazard ratio [aHR] 3.02, 95% confidence interval [CI] 2.73–3.35). The association between RA and tuberculosis was more prominent in young adults aged 20-39 years. Using the control group as the reference, the aHR of tuberculosis in bDMARD-naïve patients with RA was 2.87 (95% CI 2.58–3.19), and the aHR of tuberculosis in bDMARD-exposed patients with RA was 4.97 (95% CI 3.92–6.29). In patients with RA, male sex, advanced age, underweight, diabetes, hypertension, airway disease, and bDMARD exposure were associated with an increased risk of tuberculosis.

Conclusion: In a nationwide population-based cohort in Korea with a intermediate risk of tuberculosis, patients with RA had a three-fold higher risk of tuberculosis than age- and sex-matched controls, and even bDMARD-naïve patients had a higher risk of tuberculosis than the general population. Even in patients who do not use bDMARDs, if suspicious symptoms occur, the possibility of tuberculosis should be considered.

« Back to ACR Convergence 2023

ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-tuberculosis-in-patients-with-rheumatoid-arthritis-a-nationwide-population-based-cohort-study/