Patients with systemic necrotizing vasculitis have been shown to be at higher risk of developing tuberculosis than the general population. So far, ‘systemic necrotizing vasculitis’, an autoimmune disease, has not been properly investigated as to whether tuberculosis has increased due to its rarity.
Yonsei University Medical School Professor In-Kyung Jeong and Dr. Han Min-kyung, Yonsei University Severance Hospital Rheumatology Vasculitis Clinic Prof. Sangwon Lee, Yongin Severance Hospital Rheumatology Department Professor Seongsu Ahn’s joint research team analyzed data from the Health Insurance Review and Assessment Service. Said on the 12th that the risk of tuberculosis was 6 times higher than that of the general population.
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and transmitted through the respiratory tract. It mainly causes inflammation in the lungs, but it can cause inflammation in all parts of the body, including lymph nodes, kidneys, nervous system, and bones. According to a report by the World Health Organization (WHO), more than 10 million people get tuberculosis every year, and it is known as one of the top 10 causes of death. The risk factors for tuberculosis are old age, men, smoking, malnutrition, chronic obstructive pulmonary disease (COPD), chronic kidney failure, malignant tumors, human immunodeficiency virus (HIV) infection and autoimmune diseases.
Previous studies have reported an increase in tuberculosis in patients with autoimmune diseases such as rheumatoid arthritis, psoriasis and lupus. In particular, the risk of using a TNF-α inhibitor used to treat rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis is known to be used. Therefore, careful monitoring for tuberculosis is necessary in patients suffering from autoimmune diseases.
Systemic necrotizing vasculitides, which the research team wanted to identify, are divided into “anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis” and “polyarterial nodular nodular inflammation”, and cause necrotizing inflammation in small and medium blood vessels. To do. However, the outbreak of tuberculosis in patients suffering from this disease is unknown.
The research team analyzed data from a total of 2,660 patients diagnosed with systemic necrotizing vasculitis from 2010 to 2018 using data from the Health Insurance Review and Assessment Service, which includes all national data, to determine the incidence of tuberculosis in patients with systemic necrotizing vasculitis. A total of 51 patients (1.9%) developed tuberculosis during the follow-up period. Converted to a standardized incidence ratio, the total number of men and women were 6.09, men 5.95, women 6.26. This means that the risk of developing tuberculosis in patients with necrotizing vasculitis is about 6 times higher than in the general population. According to a report published last year, the total number of tuberculosis patients in Korea was 33,304 and 23,821 new patients.
In addition, the risk of tuberculosis was increased in all disease subtypes of systemic necrotizing vasculitis, except for eosinophilic granulomatous polyangiitis. In addition, tuberculosis most often occurred within the first 3 months after diagnosis, and the incidence within 3 months was about 8.9 times higher than the incidence 12 months after diagnosis. Important factors associated with the incidence of tuberculosis were patients diagnosed with micropolyangiitis, granulomatous polyangiitis and polyarterial tuberculitis, and the incidence of tuberculosis was increased in these diseases.
Professor Lee Sang-won said: “In general, patients with autoimmune diseases are known to have an increased risk of developing tuberculosis. However, due to the scarcity of the disease, the increase in tuberculosis in patients with systemic necrotizing vasculitis has not yet been studied. Using data from the Health Insurance Review and Assessment Service The analysis of data from a total of 2,660 patients showed that patients with systemic necrotizing vasculitis have an increased incidence of tuberculosis, especially in the early stages of diagnosis. ”Professor Seong-soo Ahn said, “This is the first paper to discover that the incidence of TB is increasing in patients with systemic necrotizing vasculitis, and we can also confirm that there is a difference in the incidence of TB depending on the subtype of the disease.” think it is necessary to monitor the occurrence of tuberculosis in the treatment of patients. “
The study was published last month in Frontiers in Medicine (IF 3,900), “ Incidence of Tuberculosis in Systemic Necrotizing Vasculitides: A Population-Based Study From an Intermediate Burden) ”.
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