Tuberculosis in patients with systemic lupus erythematosus-a 37-year longitudinal survey-based study
© 2020 The Association for the Publication of the Journal of Internal Medicine..
BACKGROUND: Infections are one of the most common causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE). SLE patients have a higher risk of tuberculosis (TB) infection due to impaired immune defence.
OBJECTIVES: To investigate the demographics, clinical characteristics and outcomes of patients with SLE and concomitant TB.
METHODS: Medical records of SLE patients with TB who were admitted to Peking Union Medical College (PUMC) Hospital in 1983-2019 were retrospectively reviewed. Age- and sex-matched SLE inpatients without TB were randomly selected as controls. Clinical and laboratory features and treatment were analysed and compared, and subjects were followed up to assess their outcome.
RESULTS: Of the 10 469 SLE inpatients, 249 (2.4%) were diagnosed with TB. Compared with controls, SLE/TB + patients exhibited higher frequency of prior haematologic, mucocutaneous and musculoskeletal system involvement, and prior treatment with potent glucocorticoid/immunosuppressive agents (GC/ISA). Arthritis and alopecia, positive T-SPOT.TB test and lymphocytopenia were more common in SLE/TB + patients. SLE/TB + patients with lupus before TB (SLE → TB) had higher risk of miliary TB (22.8%) and intracranial TB (16.5%) than SLE/TB + patients with lupus after TB (TB → SLE). SLE/TB + patients exhibited shorter long-term survival than SLE/TB- patients; those with poorer in-hospital outcomes had more severe lymphocytopenia and had received less treatment with ISAs.
CONCLUSION: Systemic lupus erythematosus patients treated vigorously with GC/ISA should be alerted of increased risk of TB infection, especially miliary and intracranial TB. Positive T-SPOT.TB and lymphocytopenia served as discriminatory variables between SLE/TB + and SLE/TB- patients. Lymphocytopenia was associated with poorer outcomes in SLE/TB + patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:290 |
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| Enthalten in: |
Journal of internal medicine - 290(2021), 1 vom: 22. Juli, Seite 101-115 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Xiao, X [VerfasserIn] |
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| Links: |
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| Themen: |
Glucocorticoids |
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| Anmerkungen: |
Date Completed 06.10.2021 Date Revised 06.10.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/joim.13218 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM318259737 |
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| 041 | |a eng | ||
| 100 | 1 | |a Xiao, X |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Tuberculosis in patients with systemic lupus erythematosus-a 37-year longitudinal survey-based study |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 06.10.2021 | ||
| 500 | |a Date Revised 06.10.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 The Association for the Publication of the Journal of Internal Medicine. | ||
| 520 | |a BACKGROUND: Infections are one of the most common causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE). SLE patients have a higher risk of tuberculosis (TB) infection due to impaired immune defence | ||
| 520 | |a OBJECTIVES: To investigate the demographics, clinical characteristics and outcomes of patients with SLE and concomitant TB | ||
| 520 | |a METHODS: Medical records of SLE patients with TB who were admitted to Peking Union Medical College (PUMC) Hospital in 1983-2019 were retrospectively reviewed. Age- and sex-matched SLE inpatients without TB were randomly selected as controls. Clinical and laboratory features and treatment were analysed and compared, and subjects were followed up to assess their outcome | ||
| 520 | |a RESULTS: Of the 10 469 SLE inpatients, 249 (2.4%) were diagnosed with TB. Compared with controls, SLE/TB + patients exhibited higher frequency of prior haematologic, mucocutaneous and musculoskeletal system involvement, and prior treatment with potent glucocorticoid/immunosuppressive agents (GC/ISA). Arthritis and alopecia, positive T-SPOT.TB test and lymphocytopenia were more common in SLE/TB + patients. SLE/TB + patients with lupus before TB (SLE → TB) had higher risk of miliary TB (22.8%) and intracranial TB (16.5%) than SLE/TB + patients with lupus after TB (TB → SLE). SLE/TB + patients exhibited shorter long-term survival than SLE/TB- patients; those with poorer in-hospital outcomes had more severe lymphocytopenia and had received less treatment with ISAs | ||
| 520 | |a CONCLUSION: Systemic lupus erythematosus patients treated vigorously with GC/ISA should be alerted of increased risk of TB infection, especially miliary and intracranial TB. Positive T-SPOT.TB and lymphocytopenia served as discriminatory variables between SLE/TB + and SLE/TB- patients. Lymphocytopenia was associated with poorer outcomes in SLE/TB + patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a T-SPOT.TB | |
| 650 | 4 | |a lymphocyte subsets | |
| 650 | 4 | |a lymphocytopenia | |
| 650 | 4 | |a systemic lupus erythematosus | |
| 650 | 4 | |a tuberculosis | |
| 650 | 7 | |a Glucocorticoids |2 NLM | |
| 650 | 7 | |a Immunosuppressive Agents |2 NLM | |
| 700 | 1 | |a Da, G |e verfasserin |4 aut | |
| 700 | 1 | |a Xie, X |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, X |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, L |e verfasserin |4 aut | |
| 700 | 1 | |a Zhou, B |e verfasserin |4 aut | |
| 700 | 1 | |a Li, H |e verfasserin |4 aut | |
| 700 | 1 | |a Li, P |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, H |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, H |e verfasserin |4 aut | |
| 700 | 1 | |a Fei, Y |e verfasserin |4 aut | |
| 700 | 1 | |a Tsokos, G C |e verfasserin |4 aut | |
| 700 | 1 | |a Zhao, L |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, X |e verfasserin |4 aut | |
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