Risk factors associated with tuberculosis in systemic lupus erythematosus: A case-control study in Indonesia

Abstract

Objectives

Tuberculosis (TB) may increase morbidity and mortality of systemic lupus erythematosus (SLE) patients. The aim of the study was to determine the risk factors associated with TB in SLE patients.

Methods

This case-control study included SLE patients from the Hasan Sadikin Lupus Registry (HSLR) cohort between 2008 and 2024. Lupus patients with TB (cases) were matched by age with those without TB (controls). TB risk was estimated as adjusted OR (aOR) with 95% CI using univariate and multivariable logistic regression analyses.

Results

In total, 90 SLE patients with TB and 270 without TB were included, predominantly female (n = 342; 95%). The median SLE duration to TB diagnosis was 30 (range 8-95) months, of which 56.7% (n = 51) had pulmonary TB, and 21.1% (n = 19) had extrapulmonary TB with meningitis and lymphadenitis being the most prevalent. Logistic regression analysis showed that SLE duration <9 months (aOR 4.04; 95% CI 1.78–9.18), history of TB contact (aOR 3.67; 95% CI 1.31–10.30), history of methylprednisolone ≥24 mg/day for ≥4 weeks (aOR 1.96; 95% CI 1.06–3.63), using <2 disease-modifying antirheumatic drugs (DMARDs) (aOR 3.34; 95% CI 1.89–5.90), and lymphopenia (aOR 2.84; CI 95% 1.65–4.91) were associated with TB (P < .05).

Conclusions

Among SLE patients living in TB endemic country, TB contact, high dose corticosteroid, and lymphopenia increase risk of TB. Of note, lower disease duration and using <2 DMARDs are also associated with TB. Further research is necessary to evaluate the need of TB prophylaxis in SLE patients with these risk factors.