title: Increased risk of pulmonary and extra-pulmonary tuberculosis in patients with rheumatic diseases.
abstract: METHODS
  Impaired immunity in patients with rheumatic diseases can increase the risk of pulmonary tuberculosis (PTB). However, it is less clear whether rheumatic diseases affect the risk of extra-pulmonary tuberculosis (EPTB).
  
  
  OBJECTIVE
  To investigate the risk of PTB and EPTB in patients with rheumatic diseases using a population-based database.
  
  
  METHODS
  From Taiwan's National Health Insurance Research Database, 8536 patients with tuberculosis (TB) were frequency-matched with 42,680 controls for sex, 10-year age group and index year. Subjects were retrospectively traced back for their first diagnosis of rheumatic diseases. The association between TB and rheumatic diseases was assessed using multivariate logistic regression analyses.
  
  
  RESULTS
  The risk of developing PTB was significantly higher in patients with systemic lupus erythematosus (adjusted odds ratio [aOR] 4.90, P < 0.001), rheumatoid arthritis (RA) (aOR 2.00, P < 0.001) and Sjögren's syndrome (aOR 6.11, P < 0.001). In addition, the risks of developing EPTB were significantly higher in RA patients (aOR 4.67, P < 0.001), those with Sjögren's syndrome (aOR 5.94, P < 0.001), and the group comprising progressive systemic sclerosis, polymyositis or dermatomyositis (aOR 8.31, P = 0.021).
  
  
  CONCLUSIONS
  Elevated risks of PTB and EPTB were associated with various rheumatic diseases. Rheumatologists should be vigilant to the possibility of TB, and particularly EPTB, in their patients.
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: M-C
authors.initials: MC
authors.lastname: Lu
authors.affiliation: School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Pulmonology and Critical Care, Dalin Tzu Chi Hospital, Taiwan.
authors.forename: C-L
authors.initials: CL
authors.lastname: Lai
authors.affiliation: School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Infectious Diseases, Dalin Tzu Chi Hospital, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Tsai
authors.affiliation: Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Koo
authors.affiliation: Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: N-S
authors.initials: NS
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000145:classification / Q000150:complications*; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014376:Tuberculosis / Q000145:classification / Q000453:epidemiology*; D055815:Young Adult