Vol. 19 No. 1 (2025): Revista Reumatología al Día
Articles

Riesgo de tuberculosis en pacientes con enfermedades reumatológicas y uso de terapia biológica en un hospital de tercer nivel.

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  • Ruth Almeida Guillén,
  • Mayra Castillo,
  • José Alcívar Guerra,
  • José Triana Santillán,
  • Roberto Florencia Peña
Ruth Almeida Guillén
Servicio de Reumatología, Hospital de Especialidades Teodoro Maldonado Carbo. Guayaquil, Ecuador.
Mayra Castillo
Hospital Teodoro Maldonado Carbo
José Alcívar Guerra
Servicio de Reumatología, Hospital de Especialidades Teodoro Maldonado Carbo. Guayaquil, Ecuador.
José Triana Santillán
Servicio de Reumatología, Hospital de Especialidades Teodoro Maldonado Carbo. Guayaquil, Ecuador.
Roberto Florencia Peña
Servicio de Reumatología, Hospital de Especialidades Teodoro Maldonado Carbo. Guayaquil, Ecuador.
DOI: https://doi.org/10.62484/rad.v19i1.9608

Published 2025-05-01

Keywords

  • Tuberculosis latente,
  • terapia biológica,
  • enfermedad reumática autoinmune

How to Cite

Almeida Guillén, R., Castillo, M., Alcívar Guerra, J., Triana Santillán, J., & Florencia Peña, R. (2025). Riesgo de tuberculosis en pacientes con enfermedades reumatológicas y uso de terapia biológica en un hospital de tercer nivel. Reumatología Al Día, 19(1). https://doi.org/10.62484/rad.v19i1.9608

Copyright (c) 2025 Reumatología al Día

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Abstract

Objetivo. - determinar la incidencia y riesgo de TB latente y tuberculosis activa en pacientes con enfermedades reumáticas autoinmunes que reciben terapia biológica, así como establecer los factores de riesgo asociados en esta población.

Diseño. - Se realizó un estudio transversal, retrospectivo en pacientes con enfermedades reumáticas en tratamiento con medicación biológica del Hospital de Especialidades Dr. Teodoro Maldonado Carbo de Guayaquil-Ecuador que acudieron a la consulta de reumatología entre enero de 2010 y enero de 2024. 

Resultados.- Entre los factores que mostraron asociación significativa para TB activa previo a terapia biológico se encuentra: infección por VIH/SIDA (p<0.001), enfermedad pulmonar intersticial (p=0.016), uso de leflunomida (p=0.009) y LES (p=0.006). Posterior al inicio de terapia biológica, 217 (13.8%) y 29 (1.8%) pacientes fueron catalogados con TB latente y TB activa respectivamente.  Se observó correlación bilateral significativa para reactivación de TB en sujetos con sexo masculino [OR 3.3 (IC95% 1.6 – 7) p=<0.001], AR [OR 4.3 (IC95% 1.3 – 13.7) p=0.018], EA [OR 2.4 (IC95% 1 – 5.5) p=0.037], tratamiento con Adalimumab [OR 3.1 (IC95% 1.3 – 7.1) p=0.004] y ciclofosfamida [OR 3.7 (IC95% 1.1 – 13.) p=0.025].

La tasa de incidencia de tuberculosis por 10.000 personas/año posterior a inicio del tratamiento biológico fue de 184.8 casos para TB activa y 1383 para TB latente. El riesgo de reactivación TB en la cohorte total tuvo un OR 2.9 (CI95% 1.4 – 6.2) p=0.004. No se observaron diferencias significativas para sexo, edad, tipo de enfermedad reumática autoinmune, tipo de biológico, comorbilidades o FARMES.

 

 

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References

  1. Barberis I, Bragazzi NL, Galluzzo L, Martini M. The history of tuberculosis: from the first historical records to the isolation of Koch’s bacillus. J Prev Med Hyg. 2017 Mar;58(1):E9–12.
  2. Silva DR, Muñoz-Torrico M, Duarte R, Galvão T, Bonini EH, Arbex FF, et al. Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs. J Bras Pneumol. 2018;44(2):145–52. DOI: https://doi.org/10.1590/s1806-37562017000000443
  3. Anton C, Machado FD, Ramirez JMA, Bernardi RM, Palominos PE, Brenol CV, et al. Latent tuberculosis infection in patients with rheumatic diseases. J Bras Pneumol. 2019 Apr 25;45:e20190023. DOI: https://doi.org/10.1590/1806-3713/e20190023
  4. Shobha V, Chandrashekara S, Rao V, Desai A, Jois R, Dharmanand BG, et al. Biologics and risk of tuberculosis in autoimmune rheumatic diseases: A real-world clinical experience from India. Int J Rheum Dis. 2019;22(2):280–7. DOI: https://doi.org/10.1111/1756-185X.13376
  5. He D, Bai F, Zhang S, Jiang T, Shen J, Zhu Q, et al. High Incidence of Tuberculosis Infection in Rheumatic Diseases and Impact for Chemoprophylactic Prevention of Tuberculosis Activation during Biologics Therapy. Clin Vaccine Immunol CVI. 2013 Jun;20(6):842–7. DOI: https://doi.org/10.1128/CVI.00049-13
  6. Sundbaum JK, Arkema EV, Bruchfeld J, Jonsson J, Askling J, Baecklund E. Tuberculosis in Biologic-naïve Patients With Rheumatoid Arthritis: Risk Factors and Tuberculosis Characteristics. J Rheumatol. 2021 Aug 1;48(8):1243–50. DOI: https://doi.org/10.3899/jrheum.201251
  7. Al-arbi KMS, Magula NP, Mody GM. Tuberculosis remains a major burden in systemic lupus erythematosus patients in Durban, South Africa. Front Med [Internet]. 2023 Mar 1 [cited 2025 Feb 4];10. Available from: https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1118390/full DOI: https://doi.org/10.3389/fmed.2023.1118390
  8. Glucocorticoid use, other associated factors, and the risk of tuberculosis. [cited 2025 Feb 4]; Available from: https://onlinelibrary.wiley.com/doi/10.1002/art.21705
  9. Fallahi-Sichani M, Flynn JL, Linderman JJ, Kirschner DE. Differential risk of tuberculosis reactivation among anti-TNF therapies is due to drug binding kinetics and permeability. J Immunol Baltim Md 1950. 2012 Apr 1;188(7):3169–78. DOI: https://doi.org/10.4049/jimmunol.1103298
  10. Sundaram K, Vajravelu LK, Velayutham R, Mohan U. Progression of tuberculosis among patients with rheumatic diseases – A systematic review and meta-analysis. Indian J Tuberc. 2023 Jul 6; Available from: https://www.sciencedirect.com/science/article/pii/S0019570723001294 DOI: https://doi.org/10.1016/j.ijtb.2023.07.001
  11. Kaufmann SHE. How can immunology contribute to the control of tuberculosis? Nat Rev Immunol. 2001 Oct;1(1):20–30. DOI: https://doi.org/10.1038/35095558
  12. Wallis RS. Tumour necrosis factor antagonists: structure, function, and tuberculosis risks. Lancet Infect Dis. 2008 Oct 1;8(10):601–11. DOI: https://doi.org/10.1016/S1473-3099(08)70227-5
  13. Ai JW, Zhang S, Ruan QL, Yu YQ, Zhang BY, Liu QH, et al. The Risk of Tuberculosis in Patients with Rheumatoid Arthritis Treated with Tumor Necrosis Factor-α Antagonist: A Metaanalysis of Both Randomized Controlled Trials and Registry/Cohort Studies. J Rheumatol. 2015 Dec 1;42(12):2229–37. DOI: https://doi.org/10.3899/jrheum.150057
  14. Liu X, Zhang L, Zhang F, Zeng X, Zhao Y, Wang Q, et al. Prevalence and risk factors of active tuberculosis in patients with rheumatic diseases: a multi-center, cross-sectional study in China. Emerg Microbes Infect. 10(1):2303–12. DOI: https://doi.org/10.1080/22221751.2021.2004864
  15. Cagatay T, Bingol Z, Kıyan E, Yegin Z, Okumus G, Arseven O, et al. Follow-up of 1887 patients receiving tumor necrosis-alpha antagonists: Tuberculin skin test conversion and tuberculosis risk. Clin Respir J. 2018;12(4):1668–75. DOI: https://doi.org/10.1111/crj.12726
  16. Askling J, Fored CM, Brandt L, Baecklund E, Bertilsson L, Cöster L, et al. Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden. Arthritis Rheum. 2005 Jul;52(7):1986–92. DOI: https://doi.org/10.1002/art.21137
  17. Sartori NS, Picon P, Papke A, Neyeloff JL, Chakr RM da S. A population-based study of tuberculosis incidence among rheumatic disease patients under anti-TNF treatment. PLOS ONE. 2019 Dec 2;14(12):e0224963. DOI: https://doi.org/10.1371/journal.pone.0224963
  18. Wang X, Wong SH, Wang XS, Tang W, Liu CQ, Niamul G, et al. Risk of tuberculosis in patients with immune-mediated diseases on biological therapies: a population-based study in a tuberculosis endemic region. Rheumatology. 2019 May 1;58(5):803–10. DOI: https://doi.org/10.1093/rheumatology/key364
  19. Cantini F, Nannini C, Niccoli L, Iannone F, Delogu G, Garlaschi G, et al. Guidance for the management of patients with latent tuberculosis infection requiring biologic therapy in rheumatology and dermatology clinical practice. Autoimmun Rev. 2015 Jun 1;14(6):503–9. DOI: https://doi.org/10.1016/j.autrev.2015.01.011
  20. Hai BB, Anh TL, Thu PNT, Van HN, Van GV, Van DH. Latent and active tuberculosis development in patients with rheumatoid arthritis receiving biologic disease-modifying antirheumatic drugs: A single-center prospective study. PLOS ONE. 2024 Jan 11;19(1):e0295048. DOI: https://doi.org/10.1371/journal.pone.0295048
  21. İlgen U, Karadağ Ö, Emmungil H, Küçükşahin O, Koca SS, Erden A, et al. Tuberculin skin test before biologic and targeted therapies: does the same rule apply for all? Rheumatol Int. 2022 Oct 1;42(10):1797–806. DOI: https://doi.org/10.1007/s00296-022-05134-z
  22. Heemskerk D, Caws M, Marais B, Farrar J. Clinical Manifestations. In: Tuberculosis in Adults and Children. Springer; 2015 [cited 2025 Feb 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK344404/ DOI: https://doi.org/10.1007/978-3-319-19132-4_3
  23. WHO consolidated guidelines on tuberculosis: module 4: treatment: drug-susceptible tuberculosis treatment. Available from: https://www.who.int/publications/i/item/9789240048126
  24. Dixon WG, Hyrich KL, Watson KD, Lunt M, Galloway J, Ustianowski A, et al. Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the British Society for Rheumatology Biologics Register (BSRBR). Ann Rheum Dis. 2010 Mar 1;69(3):522–8. DOI: https://doi.org/10.1136/ard.2009.118935
  25. Rotar Z, Svetina P, Tomsic M, Hočevar A, Prapotnik S. Tuberculosis among patients treated with TNF inhibitors for rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis in Slovenia: a cohort study. BMJ Open. 2020 Feb 1;10(2):e034356. DOI: https://doi.org/10.1136/bmjopen-2019-034356
  26. Pettipher C, Benitha R. Tuberculosis in biologic users for rheumatic diseases: results from the South African Biologics Registry (SABIO). Ann Rheum Dis. 2020 Feb 1;79(2):292–9. DOI: https://doi.org/10.1136/annrheumdis-2019-216128