Risk factors of progression to active tuberculosis in rheumatic patients with latent tuberculosis: a retrospective study

Background: The diminished immune response observed in individuals with rheumatic diseases is a contributing factor to the occurrence of tuberculosis (TB) infection. The primary objectives of this investigation were to examine the risk factors associated with the advancement of rheumatic diseases in conjunction with latent tuberculosis infection (LTBI) leading to active tuberculosis (ATB). Methods: A retrospective study was conducted at the Xijing Hospital of the Fourth Military Medical University, utilizing the Laboratory Information System (LIS), to investigate rheumatic diseases diagnosed between January 2012 and October 2022. The collected data underwent statistical analysis using the Social Science Statistical Package (SPSS) version 26, with a significance level of p < 0.05 indicating statistical significance. Results: The research conducted involved a total of 33,020 individuals diagnosed with rheumatic conditions, of which only 18.16% underwent screening for latent tuberculosis infection (LTBI). Among the rheumatic patients, the incidence of LTBI was found to be 25.33%, with 14.57% of these cases progressing to active tuberculosis (ATB). Utilizing binary logistic regression analysis, it was determined that exposure to glucocorticoids (GCs) at a dosage of 20 mg/d or higher was an independent risk factor for the development of ATB [odds ratios (OR) = 3.59, 95% CI: 1.26-10.29, p = 0.017]. Conclusion: It is of the utmost importance to perform a screening for LTBI prior to commencing treatment in patients with rheumatic conditions, as they are at a significantly elevated risk of developing ATB due to their exposure to medium-high doses of glucocorticoids (GCs). Keywords: Latent tuberculosis infection; Active tuberculosis; Rheumatic diseases; Risk factors