Patients with systemic necrotizing vasculitis, tuberculosis attention!

A study on the data of 2,660 people diagnosed from 2010 to 2018 by the Insurance Review and Assessment Service

Patients with systemic necrotizing vasculitis have a 6 times higher risk of developing tuberculosis than the general population.

It has been found that patients with systemic necrotizing vasculitis have a higher risk of developing tuberculosis than the general population. Until now, in patients with autoimmune disease’systemic necrotizing vasculitis’, the increase in tuberculosis due to the scarcity of the disease was not studied.

Yonsei University Medical School Professor In-Gyeong Jeong and Dr. Han Min-kyung, Yonsei University Severance Hospital Rheumatic Medicine Vasculitis Clinic Prof. Sang-won Lee, Yongin Severance Hospital Rheumatology Internal Medicine Professor Sungsoo Ahn’s joint research team analyzed data from the National Health Insurance Review and Assessment Service. It was revealed that the risk of tuberculosis was about six times higher than that of the population.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and is 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 each year, and it is one of the top 10 causes of death. As risk factors for tuberculosis, old age, men, smoking, malnutrition, chronic obstructive pulmonary disease (COPD), chronic kidney failure, malignant tumors, human immunodeficiency virus (HIV) infection, and autoimmune diseases have been known.

Previous studies have reported increased tuberculosis in patients with autoimmune diseases such as rheumatoid arthritis, psoriasis, and lupus. In particular, the use of a TNF-α inhibitor used in the treatment of rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis is known to increase the risk. Therefore, careful monitoring of tuberculosis is necessary in patients suffering from autoimmune diseases.

Systemic necrotizing vasculitides, which the research team wanted to identify, are divided into’antineutrophilic antibody (ANCA)-associated vasculitis’ and’polyarterial nodular nodular inflammation’, and cause necrotizing inflammation in small and medium-sized blood vessels. do. However, the incidence of tuberculosis in patients with this disease is unknown.

The research team analyzed the data of a total of 2,660 patients diagnosed with systemic necrotizing vasculitis from 2010 to 2018 using data from the National 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. When this was converted into a standardized incidence ratio, the total male and female were 6.09, male 5.95, female 6.26. This means that the risk of tuberculosis in patients with necrotizing vasculitis is about 6 times higher than that of the general population.

According to a recent (2019) report, the total number of tuberculosis patients in Korea was 30,304 and the number of new patients was 23,821.

In addition, the risk of tuberculosis was increased in all of the disease subtypes of systemic necrotizing vasculitis, except for eosinophilic granulomatous polyangiitis. In addition, tuberculosis occurred most frequently within the first 3 months after diagnosis, and the incidence rate within 3 months was approximately 8.9 times higher than the incidence rate 12 months after diagnosis.

Significant 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 probability of developing tuberculosis. However, the increase in tuberculosis in patients with systemic necrotizing vasculitis due to the scarcity of the disease has not been studied. As a result of analyzing the data of a total of 2,660 patients using data from the National Health Insurance Review and Assessment Service, it was found that patients with systemic necrotizing vasculitis have an increased incidence of tuberculosis, especially in the early stages of diagnosis.”

Professor Ahn Seong-su said, “This is the first paper to find out that the incidence of tuberculosis is increased in patients with systemic necrotizing vasculitis. Through the results of the study, it is thought that the careful attention to the occurrence of tuberculosis is necessary while treating patients with these diseases in the future.”

This study was published in Frontiers in Medicine (IF 3.900) in October, “Incidence of Tuberculosis in Systemic Necrotizing Vasculitides: A Population-Based Study. From an Intermediate-Burden Country)’.

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