Clinical Characteristics And Related Factors Of Common Rheumatic Diseases Complicated With Tuberculosis Infection

Objective: To explore the clinical characteristics and high risk factors of common systemic rheumatism complicated with tuberculosis infection.Methods:A total of 3,906 cases of RA,SLE,and SS common systemic rheumatism diagnosed in the People's Hospital of Sichuan Province from January 2007 to January2017 were collected.Patients with TB were selected with carefully exclusion with other infectious diseases other connective tissue diseases and neoplastic disease.One hundred and five patients with TB were included as infection group,including 42 cases of RA,41 cases of SLE,and 22 cases of SS.In the control group,84 patients with RA,82 patients with SLE,and 44 patients with SS were randomly selected from the corresponding rheumatoid non-infected patients hospitalized during the same period.Theclinical data,laboratory results,and therapeutic data were compared between the two groups.Results:1.Fever was the most common symptom among 42 cases of RA,41 cases of SLE,and 22 cases of SS with TB,accounting for 83.3%,92.7%,and 68.2%,respectively.Secondly,cough,weight loss or fatigue were common.2.Forty-two cases of RA with TB were mostly pulmonary TB,accounting for 73.3%,and extra-pulmonary TB included 6 cases(14.2%)of joint tuberculosis,2 cases(4.8%)of lymph node tuberculosis,and 1 case(2.4%)of tuberculous peritonitis,Two cases(4.8%)of tuberculosis infection site are unknown.For 41 cases of SLE and 22 cases of SS with TB,the proportion of pulmonary was 58.5%,72.7%,respectively.And extra-pulmonary tuberculosis was 26.8%,9.1%,respectively.For SLE,extra-pulmonary TB included 6cases(14.6%)of tuberculous meningitis,and 4 cases(9.8%)of joint tuberculosis.Two or more lesions included 1 case(2.4%)of phthisis with tuberculous pleurisy,1 case(2.4%)of phthisis with tuberculous peritonitis,and 1 case(2.4%)of phthisis with tuberculous meningitis.Three cases(7.3%)of tuberculosis infection site are unknown.For SS,extra-pulmonary TB were 1 case(4.5%)of bone and joint tuberculosis,and 1 case(4.5%)of tuberculous pericarditis.One case(4.5%)had tuberculosis with tuberculous meningitis,and one case(4.5%)had tuberculosis with thoracic tuberculosis.Two cases(9.1%)of tuberculosis infection site are unknown.3.In TB infection group,27 cases of RA,21 cases of SLE,and 13 cases of SS with TB had two or more chest CT findings,accounting for 59%,57%,62%,respectively.Lesions located in the posterior or posterior segment which TB usually affected were 9 cases(33.3%),9cases(42.9%),8cases(53.3%),respectively.4.Forty-eight patients with TB(45.7%)were received both Gamma interferon release test(IGRA)and tuberculin skin test(TST).Twenty cases(41.7%)were positive in both cases(10 cases were strongly positive for TST),24 cases(50.0%)with positive IGRA,and 2cases(4.2%)with positive TST alone(one were strongly positive).Of the 26 patients with TST negative,24(92.3%)were positive for IGRA.Of the 4 IGRA-negative patients,2(50%)were positive for TST,and 1(25%)was strongly positive.Overall,the positive rate of IGRA was 91.8%,and the positive rate of TST was 45.8.The difference was statistically significant(P<0.05).5.Compared with the control group,the ESR and CRP levels in TB infection group were increased(P<0.05).6.The daily average dose of hormones within 1 year in TB infection group was higher than that in the control group(P<0.05).For SLE patients,lower counts of CD4+TL were found in TB infection group(P<0.05),while no such differences were found in RA and SS group.7.For SLE patients,lower counts of CD4+TL were found in TB infection group(P<0.05),while no such differences were found in RA and SS group.8.There were no statistical differences between the two groups in gender,age,duration of disease,disease activity score,WBC,IgG complements,autoantibodies and immunosuppressant used.Conclusion: 1.Patients with RA,SS and SLE who have TB infection are mainly pulmonary TB.2.Symptoms of RA,SLE,SS with TB,such as fever,cough,weight loss,fatigue,are similar with the primary disease or other infection.Chest imaging is diversity.It isdifficult to diagnose.3.Daily average dose of hormone within one year may be a common risk factor for RA,SLE and SS patients with TB.Decreased CD4+TL may also be a risk factor for SLE patients with TB.4.For patients with RA,SLE,and SS who have a large daily dose of hormones for a long time,if they have systemic manifestations such as fever,besides considering disease activity or common pathogen infections,they should be highly alert to the presence of TB.It is recommended to receive both TST and IGRA to help diagnose TB...