Background/Purpose: SLE patients are at high risk for tuberculosis (TB) infection especially in endemic countries. Despite the importance of this infection condition, there are still some uncertainties regarding a better characterization of this subgroup of SLE patients which variesamong different series. Screening for TB is routinely performed before immunobiological therapy but this procedure is not always considered for SLE patients starting glucocorticoid or immunosuppressive therapies, and is still under discussion. The aim of the present study was to evaluate clinical and epidemiological characteristics of SLE patients that developed TB after SLE onset.

Methods: SLE patients (2012 SLICC criteria) regularly followed in a single tertiary Lupus center in Brazil who were diagnosed with TB after SLE onset between 2000-2023 were included. Data of SLE patients were obtained from a direct interview and physical examination, and also confirmed in our ongoing prospective electronic chart database established in 2000 that consisted of an extensive clinical and laboratorial evaluation of each patient, including variables of this study, at one to six months intervals.

Results: Sixty-seven (5.3%) SLE patients with TB were identified in a total of 1,254. These SLE patients had a mean age of 48 (±13.6) years. Median time between SLE onset and TB diagnosis was 10 (±7.42) years. Regarding infection site, 33 patients (49.3%) had pulmonary tuberculosis and 34 (50.7%) with extrapulmonary tuberculosis (EPTB). Twelve patients (18%) were diagnosed with disseminated infection. The most frequent EPTB sites were lymph nodes (10.4%) and osteoarticular (8.9%), followed by similar rates of gastrointestinal tract (3%), pleural (3 %), skin and soft tissue (3%) and central nervoussystem (3%). At time of TB diagnosis, 51 patients (76%) were in use of glucocorticoid therapy with a median dose of prednisone of 7.5 mg/day (min. 0 mg/day – max. 60 mg/day). The most common DMARD agents used at TB onset were hydroxychloroquine (55%), azathioprine (31%), mycophenolate mofetil (25%), and methotrexate (12%). Adverse events to TB therapy occurred in 22 patients (32%), with most frequently reported side effects being hepatotoxicity and gastrointestinal intolerance.

Conclusion: Our results demonstrated that SLE patients have a high prevalence of tuberculosis, especially extrapulmonary tuberculosis.The use of glucocorticoid therapy was frequently observed at time of TB diagnosis but other immunossupressive drugs could also contribute to increase the risk of this infection.Further studies should be performed in order to define the role of screening of latent TB in SLE patients living in endemic areas.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sle-patients-are-at-high-risk-for-tuberculosis-infection-data-from-a-lupus-center-of-an-endemic-country/