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Article: Tuberculosis in systemic lupus erythematosus in an endemic area and the role of isoniazid prophylaxis during corticosteroid therapy

TitleTuberculosis in systemic lupus erythematosus in an endemic area and the role of isoniazid prophylaxis during corticosteroid therapy
Authors
Issue Date2005
PublisherJournal of Rheumatology Publishing Co Ltd. The Journal's web site is located at http://www.jrheum.com
Citation
Journal Of Rheumatology, 2005, v. 32 n. 4, p. 609-615 How to Cite?
AbstractObjective. The efficacy of isoniazid (INAH) prophylaxis against tuberculosis (TB) in patients taking corticosteroid remains controversial. Hong Kong is an endemic area for TB, with an annual risk of 0.11/100 in the general population. Patients with systemic lupus erythematosus (SLE) have an increased susceptibility to TB because of their intrinsic immunocompromised state and the use of corticosteroid therapy. We examined the usefulness of INAH in the prevention of recurrences of TB in patients with SLE receiving high dose corticosteroid therapy. Methods. Medical records of a cohort of patients with SLE were reviewed. Patients with a history of TB who had previously been adequately treated were retrospectively examined for subsequent recurrence of TB. A comparison was performed based on the use of INAH at the discretion of the attending physician in some patients (INAH group) but not others (non-INAH group) during lupus exacerbation that required the use of prednisolone ≥ 15 mg/day or equivalent. Results. A total of 91 episodes of TB from 76 individuals in a cohort of 652 SLE patients with a duration of followup of 13.9 ± 7.5 years were identified (prevalence of 1.06/100 patient-years). 43 episodes were given INAH while 48 were not. There were 18 recurrences of TB (recurrence rate of 1.66/100 patient-years). Recurrence rates in the INAH and non-INAH groups were 1.59 and 1.74 per 100 patient-years (p = 0.72). However, patients in the INAH group had more lupus exacerbations. Further, extrapulmonary TB was also found to have a higher recurrence rate than pulmonary TB. A case-controlled analysis was thus performed (n = 46) matching patients for the number of lupus exacerbations, cumulative doses of prednisolone, and initial site of TB. There was no difference in the recurrence rates of TB between the matched INAH (0.55/100 patient-years) and non-INAH (1.04/100 patient-years) groups (p = 0.66). Conclusion. Patients with SLE have a higher prevalence of TB infection than the general population. They are at risk of TB recurrence when given immunosuppressive doses of corticosteroid.
Persistent Identifierhttp://hdl.handle.net/10722/76473
ISSN
2015 Impact Factor: 3.236
2015 SCImago Journal Rankings: 1.225
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorMo, YMen_HK
dc.contributor.authorLo, Yen_HK
dc.contributor.authorTak, MCen_HK
dc.contributor.authorWoon, SWen_HK
dc.contributor.authorChak, SLen_HK
dc.date.accessioned2010-09-06T07:21:36Z-
dc.date.available2010-09-06T07:21:36Z-
dc.date.issued2005en_HK
dc.identifier.citationJournal Of Rheumatology, 2005, v. 32 n. 4, p. 609-615en_HK
dc.identifier.issn0315-162Xen_HK
dc.identifier.urihttp://hdl.handle.net/10722/76473-
dc.description.abstractObjective. The efficacy of isoniazid (INAH) prophylaxis against tuberculosis (TB) in patients taking corticosteroid remains controversial. Hong Kong is an endemic area for TB, with an annual risk of 0.11/100 in the general population. Patients with systemic lupus erythematosus (SLE) have an increased susceptibility to TB because of their intrinsic immunocompromised state and the use of corticosteroid therapy. We examined the usefulness of INAH in the prevention of recurrences of TB in patients with SLE receiving high dose corticosteroid therapy. Methods. Medical records of a cohort of patients with SLE were reviewed. Patients with a history of TB who had previously been adequately treated were retrospectively examined for subsequent recurrence of TB. A comparison was performed based on the use of INAH at the discretion of the attending physician in some patients (INAH group) but not others (non-INAH group) during lupus exacerbation that required the use of prednisolone ≥ 15 mg/day or equivalent. Results. A total of 91 episodes of TB from 76 individuals in a cohort of 652 SLE patients with a duration of followup of 13.9 ± 7.5 years were identified (prevalence of 1.06/100 patient-years). 43 episodes were given INAH while 48 were not. There were 18 recurrences of TB (recurrence rate of 1.66/100 patient-years). Recurrence rates in the INAH and non-INAH groups were 1.59 and 1.74 per 100 patient-years (p = 0.72). However, patients in the INAH group had more lupus exacerbations. Further, extrapulmonary TB was also found to have a higher recurrence rate than pulmonary TB. A case-controlled analysis was thus performed (n = 46) matching patients for the number of lupus exacerbations, cumulative doses of prednisolone, and initial site of TB. There was no difference in the recurrence rates of TB between the matched INAH (0.55/100 patient-years) and non-INAH (1.04/100 patient-years) groups (p = 0.66). Conclusion. Patients with SLE have a higher prevalence of TB infection than the general population. They are at risk of TB recurrence when given immunosuppressive doses of corticosteroid.en_HK
dc.languageengen_HK
dc.publisherJournal of Rheumatology Publishing Co Ltd. The Journal's web site is located at http://www.jrheum.comen_HK
dc.relation.ispartofJournal of Rheumatologyen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAntibiotic Prophylaxisen_HK
dc.subject.meshAntitubercular Agents - therapeutic useen_HK
dc.subject.meshAzathioprine - therapeutic useen_HK
dc.subject.meshEndemic Diseasesen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshGlucocorticoids - adverse effectsen_HK
dc.subject.meshHong Kong - epidemiologyen_HK
dc.subject.meshHumansen_HK
dc.subject.meshImmunocompromised Host - drug effects - immunologyen_HK
dc.subject.meshImmunosuppressive Agents - therapeutic useen_HK
dc.subject.meshIsoniazid - therapeutic useen_HK
dc.subject.meshLupus Erythematosus, Systemic - complications - drug therapy - epidemiology - immunologyen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshMycobacterium tuberculosis - isolation & purificationen_HK
dc.subject.meshPrednisolone - adverse effectsen_HK
dc.subject.meshRecurrenceen_HK
dc.subject.meshTuberculosis - complications - epidemiology - immunology - prevention & controlen_HK
dc.titleTuberculosis in systemic lupus erythematosus in an endemic area and the role of isoniazid prophylaxis during corticosteroid therapyen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0315-162X&volume=32&issue=4&spage=609&epage=615&date=2005&atitle=Tuberculosis+in+systemic+lupus+erythematosus+in+an+endemic+area+and+the+role+of+isoniazid+prophylaxis+during+corticosteroid+therapy.en_HK
dc.identifier.emailMo, YM:temy@hkucc.hku.hken_HK
dc.identifier.emailTak, MC:dtmchan@hku.hken_HK
dc.identifier.authorityMo, YM=rp00490en_HK
dc.identifier.authorityTak, MC=rp00394en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.pmid15801014en_HK
dc.identifier.scopuseid_2-s2.0-17144415925en_HK
dc.identifier.hkuros99033en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-17144415925&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume32en_HK
dc.identifier.issue4en_HK
dc.identifier.spage609en_HK
dc.identifier.epage615en_HK
dc.identifier.isiWOS:000228370500008-
dc.publisher.placeCanadaen_HK
dc.identifier.scopusauthoridMo, YM=7006024184en_HK
dc.identifier.scopusauthoridLo, Y=35148230000en_HK
dc.identifier.scopusauthoridTak, MC=7402687700en_HK
dc.identifier.scopusauthoridWoon, SW=8617524400en_HK
dc.identifier.scopusauthoridChak, SL=8617524500en_HK

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