TB may increase the risk for systemic vasculitides

The risk for systemic vasculitides (SV) is increased among patients with tuberculosis (TB), especially among those with extrapulmonary disease, according to study findings published in Rheumatology.

As a result of the immune system response to Mycobacterium tuberculosis infection, excessive inflammation may result in dysregulation of the immune system and the development of autoimmune diseases. Therefore, investigators in South Korea explored the association between TB and the incidence of SV: a group of rare autoimmune disorders characterized by inflammation of the blood vessel walls.

The investigators conducted a population-based cohort study using deidentified data from the Health Insurance Review and Assessment Service database between 2009 and 2021. They identified patients with TB, as well as control participants without TB who had undergone appendectomy. Diagnoses of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), Takayasu arteritis, giant cell arteritis, polyarteritis nodosa, and Behçet disease were included under the definition of SV.

The investigators identified 418,677 patients with TB (mean age, 50.0 years; 43.8% women; 86.6% with pulmonary TB) and 160,289 control participants. Patients in the TB group compared with the control group were more often older, men, and had comorbidities (all P <.001).

The SV incidence rate was higher among patients in the TB group (237/1,000,000 person-years [PY]) vs the control group (125/1,000,000 PY), with an overall rate of 192/1,000,000 PY during a mean follow-up of 7.5 years.

In the TB group compared with the control group, the incident rate ratio (IRR) for SV was 1.90 (95% CI, 1.63-2.22); IRRs were significantly higher among the TB group vs the control group for most disease subgroups, including Behçet disease (IRR, 1.58; 95% CI, 1.33-1.88), Takayasu arteritis (IRR, 3.61; 95% CI, 1.39-9.37), and AAV (IRR, 7.35; 95% CI, 3.96-13.62).

The TB group was independently associated with an elevated risk for SV (adjusted hazard ratio [aHR], 1.72; 95% CI, 1.45-2.05), according to Cox regression analyses. The risk for SV was significantly higher among patients with extrapulmonary TB (aHR, 4.28; 95% CI, 3.52-5.21) but not among those with pulmonary TB (aHR, 1.19; 95% CI, 0.99-1.43), when compared against control participants.

Results of a stabilized inverse probability of treatment weighting analysis showed identical findings.

The incidence of SV was highest during the 3-month interval directly preceding TB diagnosis and treatment (TB group) or appendectomy (control group) (adjusted IRR, 4.63; 95% CI, 3.73-5.76).

Study limitations included the retrospective design, lack of information concerning occupational factors, smoking habits, alcohol consumption, and individual laboratory test results, and the inability to compare results with those from healthy individuals.

“Clinical vigilance is required in patients with tuberculosis for early diagnosis and initiation of treatment,” the researchers concluded.


Han M, Ha JW, Jung I, Kim CY, Ahn SS. Incidence of systemic vasculitides after Mycobacterium tuberculosis infection: a population-based cohort study in Korea. Rheumatology (Oxford). Published online March 20, 2024. doi:10.1093/rheumatology/keae185

Source: Rheumatology Advisor

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By Ron Goldberg

Published: May 7, 2024, 10:07 p.m.

Last updated: May 15, 2024, 9:10 p.m.

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