Active and latent tuberculosis in patients with systemic lupus erythematosus living in the United States

Abstract

Background: The prevalence and clinical course of tuberculosis infection have not been well described in patients with systemic lupus erythematosus (SLE) in the United States.

Objective: This study documents the demographic, clinical, and laboratory characteristics and outcomes of patients with SLE and latent tuberculosis infection (LTBI) or active TB in an ethnically diverse clinic.

Methods: We conducted a retrospective review of clinical records of patients with SLE followed during 2005 in a county community hospital rheumatology clinic, with a large immigrant population. Clinical characteristics were analyzed according to the patients' ethnicity, tuberculin skin test (TST) results, and history of treatment for latent or active TB.

Results: Data regarding a history of active TB or TST status were available for 187 of 220 patients seen in 2005 (85%). The prevalence of TB infection was highest in patients from TB endemic areas. Fourteen patients (7%) had active TB and 33 patients (18%) had LTBI. Among the 6 patients who developed active TB after the onset of SLE, 2 had pulmonary, 1 had extrapulmonary, and 3 had disseminated TB. Laboratory features and treatment regimens for SLE were similar in patients with a history of TB infection and in patients with a negative TST.

Conclusions: A significant number of patients with SLE in a county clinic population in the United States had LTBI or TB. Treatment of active TB and latent TB yielded good outcomes with no deaths. US clinicians should consider screening SLE patients for LTBI, especially those from TB endemic areas.