Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
The aim of this work is to study the prevalence of mycobacterial infection (M.I.), the associated factors and their clinical significance in patients included in a large SLE cohort.
Retrospective descriptive study of RELESSER patients with a history of M.I. and analysis of the factors associated with the infection of this etiology.
In RELESSER 3,658 SLE patients were included. 90% are women with a mean age of 32.9 years. 93% are Caucasians. The mean follow-up time (± S.D.) was 120.2 (± 87.6) months. 705 (19.3%) patients had at least a serious infection, 1,227 serious infections occurred. M.I. were diagnosed in 42 patients (1.2% of all RELESSER patients, 3.4% of all serious infections), 85.7% women. The incidence rate of mycobacterial infection was 1 per 1,000 patients/year (95%CI:0.7-1.4).
M.I. presentation was pulmonary in 18 (42.9%) patients and extrapulmonary in 24 (57.1%) patients [joints in 8 (19.0%) patients, soft tissue in 6 (14.3%) and other sites in 10 (23.8%)]. The extrapulmonary form was associated with the use of immunosuppressants: 84.6% of the 13 patients treated with immunosuppressive drugs versus 44.4% of the 27 patients without (p=0.01). We did not observe this association with the use of corticosteroids.
To study the factors associated with mycobacterial infection, we performed a bivariate analysis including the variables associated with severe infection identified in RELESSER (age, sex, ethnicity, use of corticosteroids, immunosuppressants, antimalarials, previous admission by SLE activity, use of rituximab, use of anti-TNF, Katz severity index, SDI damage index, SLEDAI activity index and Charlson comorbidity index). There is a statistically significant association with previous admission by SLE activity (RR:2.9, 95-95%:1.3-6.2, p=0.007), renal impairment (RR:2.0, CI 95%:1,1-3,7, p=0,04), the Katz score (RR:2.1, 95% CI:1.1- 4.0, p=0.04) and the Charlson index (RR: 2.5; 95% CI: 1.3-4.8, p=0.009). The accumulated damage (SDI> 0) was closely associated with significance:RR: 2.0; 95% CI: 1.0-4.0, p=0.07. The use of immunosuppressants was associated with a significant increase in the risk of mycobacterial infection: RR:4.3; 95% CI:2.2-8.3, p=0.31.
Two patients (4.8%) died (1 respiratory and 1 extrapulmonary). The mean survival after diagnosis in these cases was 21 days.
M.I. in RELESSER affects 1.15% of patients. Its incidence rate is 1 per 1,000 patients/year (95%CI:0.7-1.4). Extrapulmonary localization affects more than half of the patients and is associated with the use of immunosuppressants. Previous admission by SLE activity, renal involvement, severity of SLE, and increased number of associated comorbidities are factors associated with the existence of mycobacterial infection.
To cite this abstract in AMA style:Lois-Iglesias A, del Campo-Pérez V, Rúa-Figueroa I, Mouriño-Rodriguez C, López Longo FJ, Galindo M, Calvo-Alen J, Ibañez Ruán J, Olivé A, Melero González RB, Fernandez-Nebro A, Bernal JA, Erausquin C, Tomero E, Horcada ML, Uriarte E, Freire M, Montilla-Morales CA, Sánchez Atrio A, Boteanu A, Diez Alvarez E, Narváez J, Martínez Taboada V, Silva Fernández L, Ruiz Lucea E, Andreu JL, Hernández Beiraín J, Gantes M, Hernández-Cruz B, Perez Venegas JJ, Pecondón Español Á, Lozano-Rivas N, Ibanez Barcelo M, Bonilla G, Torrente V, Castellví I, Alegre JJ, Moreno M, Marenco de la Fuente JL, Magro-Checa C, Vázquez Rodríguez T, Quevedo V, Richi P, Oton Sanchez MT, Pego-Reigosa J. Mycobacterial Infection in Systemic Lupus Erythematosus: Clinical Significance and Associated Factors. Data from the Registry of Patients with SLE of the Spanish Society of Rheumatology (RELESSER) [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/mycobacterial-infection-in-systemic-lupus-erythematosus-clinical-significance-and-associated-factors-data-from-the-registry-of-patients-with-sle-of-the-spanish-society-of-rheumatology-relesser/. Accessed September 25, 2021.
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