Avaliação de tuberculose infecção em pacientes com artrites inflamatórias crônicas: dados do registro PANLAR de doenças reumáticas (PANRED)

Abstract

Tuberculosis disease (TBD) is a global public health issue, and its latent form, or tuberculosis infection (TBI), affects approximately one-quarter of the world’s population. TBI is a non-pathological state in which viable forms of Mycobacterium tuberculosis exist within the host but are contained by the immune response. Patients with immune-mediated rheumatic diseases are at risk of TBI reactivation, especially when using tumor necrosis factor (TNF) inhibitors. Different safety profiles related to TBI exist among the various disease-modifying antirheumatic drugs (DMARDs), including targeted synthetic DMARDs (tsDMARDs), conventional synthetic DMARDs (csDMARDs), and biological DMARDs (bDMARDs). The objective of the present study was to evaluate the diagnosis and treatment of TBI at the initiation of immunosuppressive therapy and during 12 months of follow-up in patients with chronic inflammatory arthritis (CIA) using different types of DMARDs, as well as the screening methods for TBI and the occurrence of TBD. This was an observational, prospective, multicenter, real-world study that included patients classified as having rheumatoid arthritis (RA), psoriatic arthritis, and axial spondyloarthritis from the PanAmerican League of Rheumatology Associations (PANLAR) Registry of Rheumatic Diseases (PANRED). TBI data from 590 patients were analyzed, with a 12-month follow-up after starting DMARD therapy, from rheumatology centers in Brazil, Argentina, Uruguay, Peru, and Paraguay. Descriptive statistics were used to summarize patient characteristics. Among the participants, 460 (78%) were women, with a mean age of 52.4±12.9 years; 279 (47.9%) were mestizos, 496 (84.1%) had RA, 321 (54.4%) were using glucocorticoids (GCs), 262 (44.4%) were on bDMARDs (mainly TNF inhibitors), 169 (28.6%) on tsDMARDs and 159 (26.9%) on csDMARDs, respectively. TBI screening was performed in 430 (72.9%) individuals at baseline. Fifty-nine patients (13.7%) were diagnosed with TBI at baseline. The screening methods used were: tuberculin skin test in 389 (90.5%); interferon-gamma release assay (IGRA) in 60 (13.9%); imaging (X-ray or chest computed tomography) in 211 (49.1%); and history of recent contact with TBD pulmonary or laryngeal in 205 (47.7%) patients. After 12 months, 99 (23%) patients underwent repeat screening, with 5 (5.0%) new cases of TBI. Two patients (0.34%) developed TBD: one using tocilizumab and GCs (5 mg/day) and another using rituximab in addition to csDMARDs. Screening and treatment of TBI were performed in most patients with CIA at the start of immunosuppressive therapy. However, a significant portion of individuals remained unscreened, highlighting the need for greater attention from attending rheumatologists in this context, with the aim of reducing the risk of TBD and its associated morbidity and mortality.