Background/Purpose: This study aimed to assess the current clinical practices of tuberculosis (TB) infection screening and TB preventive treatment (TPT) among patients with rheumatic diseases, identify challenges physicians face during diagnosis and treatment, and explore potential strategies for improvement.

Methods: A well-structured questionnaire was designed and distributed to nationwide physicians from multiple disciplines, including but not limited to rheumatology, infectious diseases, and tuberculosis departments.

Results: A total of 443 valid responses were collected and analyzed. 76% of the respondents were from general hospitals, and 71% of the respondents had treated patients with rheumatic diseases complicated by active TB in the past year. Approximately 60% of the respondents reported routinely performing TB infection screening at the initial visit of patients with rheumatic diseases. Target populations primarily included those scheduled to receive tumor necrosis factor-alpha inhibitors or Janus kinase inhibitors, and those with a history of TB exposure or previous TB infection. Common preferred screening methods included chest imaging (15.58%), the tuberculin skin test (18.06%), and interferon-gamma release assays (58.69%). Reasons for not conducting routine screening included patients’ financial burden (50.57%), perceived low risk of infection (53.45%), and minimal impact on treatment decisions (46.55%). The majority of physicians (74.49%) indicated they would recommend TPT for patients with latent TB infection, and a 3-month combination regimen of isoniazid with rifampicin was mostly preferred (60.95%). However, poor treatment adherence due to long duration and adverse drug reactions was frequently reported. Although most physicians acknowledged the necessity and safety of TPT, concerns remained regarding individualized efficacy and potential risks. Key barriers identified included poor patient compliance, drug-related side effects, and a lack of robust clinical evidence.

Conclusion: Implementing TB infection screening and preventive treatment in patients with rheumatic diseases remains suboptimal, with multiple practical challenges. Enhancing professional training, improving awareness of clinical guidelines, strengthening patient education, and optimizing screening and treatment strategies may improve feasibility and effectiveness in clinical settings. Future efforts should focus on multicenter studies and policy support to standardize and promote TB infection management, thereby improving the overall quality of care for patients with rheumatic diseases.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/current-practices-and-challenges-in-tuberculosis-screening-and-preventive-treatment-among-patients-with-rheumatic-diseases-a-multiregional-physician-survey-in-china/