Clinical characteristics and prognostic factors of non-tuberculous mycobacterial disease in patients with rheumatoid arthritis
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Background/Aims: This study aimed to identify the clinical characteristics of patients with concurrent rheumatoid arthritis (RA) and suspected non-tuberculous mycobacterial (NTM) infections as well as determine their prognostic factors. Methods: We retrospectively reviewed the medical records of 91 patients with RA whose computed tomography (CT) findings suggested NTM infection. Subsequently, we compared the clinical characteristics between patients with and without clinical or radiological exacerbation of NTM-pulmonary disease (PD) and investigated the risk factors for the exacerbation and associated mortality. Results: The mean age of patients with RA and suspected NTM-PD was 65.0 ± 10.2 years. The nodular/bronchiectatic (NB) form of NTM-PD was the predominant radiographic feature (78.0%). During follow-up, 36 patients (41.9%) experienced a radiological or clinical exacerbation of NTM-PD, whereas 12 patients (13.2%) died. Combined interstitial lung disease (ILD), microbiologically confirmed NTM-PD, and NB with the fibrocavitary (FC) form on chest CT were identified as risk factors for the clinical or radiological exacerbation of NTM-PD. Hydroxychloroquine use was identified as a good prognostic factor. Conversely, history of tuberculosis, ILD, smoking, microbiologically confirmed NTM-PD, and NB with the FC form on chest CT were identified as poor prognostic factors for mortality in suspected NTM-PD. Conclusions: ILD and NB with the FC form on chest CT were associated with NTM-PD exacerbation and mortality. Hydroxychloroquine use may lower the risk of NTM-PD exacerbation. Therefore, radiographic features and presence of ILD should be considered when predicting the prognosis of patients with RA and suspected NTM-PD.
Abstract
Background/Aims: This study aimed to identify the clinical characteristics of patients with concurrent rheumatoid arthritis (RA) and suspected non-tuberculous mycobacterial (NTM) infections as well as determine their prognostic factors. Methods: We retrospectively reviewed the medical records of 91 patients with RA whose computed tomography (CT) findings suggested NTM infection. Subsequently, we compared the clinical characteristics between patients with and without clinical or radiological exacerbation of NTM-pulmonary disease (PD) and investigated the risk factors for the exacerbation and associated mortality. Results: The mean age of patients with RA and suspected NTM-PD was 65.0 ± 10.2 years. The nodular/bronchiectatic (NB) form of NTM-PD was the predominant radiographic feature (78.0%). During follow-up, 36 patients (41.9%) experienced a radiological or clinical exacerbation of NTM-PD, whereas 12 patients (13.2%) died. Combined interstitial lung disease (ILD), microbiologically confirmed NTM-PD, and NB with the fibrocavitary (FC) form on chest CT were identified as risk factors for the clinical or radiological exacerbation of NTM-PD. Hydroxychloroquine use was identified as a good prognostic factor. Conversely, history of tuberculosis, ILD, smoking, microbiologically confirmed NTM-PD, and NB with the FC form on chest CT were identified as poor prognostic factors for mortality in suspected NTM-PD. Conclusions: ILD and NB with the FC form on chest CT were associated with NTM-PD exacerbation and mortality. Hydroxychloroquine use may lower the risk of NTM-PD exacerbation. Therefore, radiographic features and presence of ILD should be considered when predicting the prognosis of patients with RA and suspected NTM-PD.
참고문헌 (34)
- Aletaha D, "Diagnosis and management of rheumatoid arthritis : a review", JAMA, 320, pp.1360~1372 (2018)
- Doran MF, "Predictors of infection in rheumatoid arthritis", Arthritis Rheum, 46, pp.2294~2300 (2002)
- Turesson C, "Comorbidity in rheumatoid arthritis", Swiss Med Wkly, 146, pp.w14290~ (2016)
- Jani M, "Prediction of infection risk in rheumatoid arthritis patients treated with biologics : are we any closer to risk stratification?", Curr Opin Rheumatol, 31, pp.285~292 (2019)
- Ratnatunga CN, "The rise of non-tuberculosis mycobacterial lung disease", Front Immunol, 11, pp.303~ (2020)
- Lim DH, "Nontuberculous mycobacterial infection in rheumatoid arthritis patients : a single-center experience in South Korea", Korean J Intern Med, 32, pp.1090~1097 (2017)
- Cowman S, "Non-tuberculous mycobacterial pulmonary disease", Eur Respir J, 54, pp.1900250~ (2019)
- Yamakawa H, "Prognostic factors and radiographic outcomes of nontuberculous mycobacterial lung disease in rheumatoid arthritis", J Rheumatol, 40, pp.1307~1315 (2013)
- Yoo JW, "Mycobacterial diseases developed during anti-tumour necrosis factor-α therapy", Eur Respir J, 44, pp.1289~1295 (2014)
- Hayashi M, "Prognostic factors of 634 HIV-negative patients with Mycobacterium avium complex lung disease", Am J Respir Crit Care Med, 185, pp.575~583 (2012)
- Mori S, "Mortality in rheumatoid arthritis patients with pulmonary nontuberculous mycobacterial disease : a retrospective cohort study", PLoS One, 15, pp.e0243110~ (2020)
- Arnett FC, "The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis", Arthritis Rheum, 31, pp.315~324 (1988)
- Aletaha D, "2010 rheumatoid arthritis classification criteria : an American College of Rheumatology", European League Against Rheumatism collaborative initiative, 2010, pp.69, 1580~1588
- Griffith DE, "An official ATS", IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases, 2007, pp.175, 367~416
- Daley CL, "Treatment of nontuberculous mycobacterial pulmonary disease : an official ATS", ERS, IDSA clinical practice guideline, pp.Clin Infect Dis, 2020[DOI]
- Hashemi R, "Erythrocyte sedimentation rate measurement using as a rapid alternative to the Westergren method", Emerg(Tehran), 3, pp.50~53 (2015)
- Yamakawa H, "Clinical investigation of nontuberculous mycobacterial lung disease in Japanese patients with rheumatoid arthritis receiving biologic therapy", J Rheumatol, 40, pp.1994~2000 (2013)
- Bongartz T, "Incidence and mortality of Interstitial Lung Disease in rheumatoid arthritis : a population-based study", Arthritis Rheum, 62, pp.1583~1591 (2010)
- Yang JA, "AB0356 comparison of the clinical characteristics of rheumatoid arthritis patients with and without interstitial lung disease", Ann Rheum Dis, 74(Suppl 2), pp.1012~ (2015)
- Caplan L, "Corticosteroid use in rheumatoid arthritis : prevalence, predictors, correlates, and outcomes", J Rheumatol, 34, pp.696~705 (2007)
- Liao TL, "Risk factors and outcomes of nontuberculous mycobacterial disease among rheumatoid arthritis patients : a case-control study in a TB endemic area", Sci Rep, 6, pp.29443~ (2016)
- Kotilainen H, "Clinical symptoms and survival in non-smoking and smoking HIV-negative patients with non-tuberculous mycobacterial isolation", Scand J Infect Dis, 43, pp.188~196 (2011)
- Erasmus JJ, "Pulmonary nontuberculous mycobacterial infection : radiologic manifestations", Radiographics, 19, pp.1487~1505 (1999)
- Winthrop KL, "Mycobacterial diseases and antitumour necrosis factor therapy in USA", Ann Rheum Dis, 72, pp.37~42 (2013)
- Brode SK, "Increased risk of mycobacterial infections associated with anti-rheumatic medications", Thorax, 70, pp.677~682 (2015)
- Wallis RS, "Granulomatous infectious diseases associated with tumor necrosis factor antagonists", Clin Infect Dis, 38, pp.1261~1265 (2004)
- Kourbeti IS, "Biologic therapies in rheumatoid arthritis and the risk of opportunistic infections : a meta-analysis", Clin Infect Dis, 58, pp.1649~1657 (2014)
- Takei H, "Rheumatoid arthritis with nontuberculous mycobacterial pulmonary disease : a retrospective, single-centre cohort study", Mod Rheumatol, 32, pp.534~540 (2022)
- Kim Y, "Analysis of prescription patterns for rheumatoid arthritis in Korea", Yakhak Hoeji, 63, pp.341~350 (2019)
- Büyükcavlak M, "Effects of artemisinin and hydroxychloroquine on cytokines in experimental sepsis", Trop Biomed, 39, pp.547~551 (2022)
- Majzoobi MM, "Effect of hydroxychloroquine on treatment and recurrence of acute brucellosis : a single-blind, randomized clinical trial", Int J Antimicrob Agents, 51, pp.365~369 (2018)
- Teh CL, "Severe infections in systemic lupus erythematosus : disease pattern and predictors of infection-related mortality", Clin Rheumatol, 37, pp.2081~2086 (2018)
- Urabe N, "Bronchial brushing and diagnosis of pulmonary nontuberculous mycobacteria infection", Respiration, 100, pp.877~885 (2021)
- Watanabe K, "Bronchial wash culture is less valuable in patients suspected to have nontuberculous mycobacteria lung disease for bilateral bronchiectasis with nodules", Int J Mycobacteriol, 7, pp.178~182 (2018)