Background and aims To describe characteristics and risk factors for tuberculosis (TB) among Filipino systemic lupus erythematosus (SLE) patients.
Methods We analysed SLE patients diagnosed with TB at Lupus Clinics of University of Santo Tomas Hospital, Manila, Philippines. TB categories included pulmonary (PTB) only, extra-pulmonary (EPTB) single site, disseminated (DTB) defined as >1 organ involvement. Disease characteristics, cumulative steroid, average daily prednisone dose and immunosuppressive use over 3 months preceding TB diagnosis, and outcomes were compared among the 3 TB categories by one-way analysis of variance (ANOVA) and multivariate discriminant analysis.
Results 87 patients (82 females) had mean age 29.23±13.13SD (6 – 62) at TB infection, mean SLE disease duration 3.40±4.44SD (<1–23) years. There were 59 (67%) PTB, 5 (6%) EPTB, 23 (27%) DTB. Extra-pulmonary sites included 8 meningitis or brain abscess, 7 soft tissue abscess, 7 pleural effusion, 3 genitourinary, 3 arthritis, 1 hepatobiliary, 1 ileocecal, 1 cutaneous. Average SLEDAI score was 4.74±3.19SD (0 – 14), nephritis in 31 (35.63%). Average cumulative prednisone was 15.29±19.38SD (0.5–86.4) grams; mean daily prednisone was 13.87+10.5SD mg (0 – 50) with 22 patients (25.29%) taking immunosuppressives 3 months preceding TB. Significant risks for DTB were nephritis (p=0.017) and prednisone >11 mg/d (p<0.05). Sixty three (72.41%) successfully completed anti-TB treatment. Among 24 deaths, 9 were attributed to TB (6 disseminated, 3 PTB respiratory failure), 15 due to active lupus.
Conclusions In this cohort, nephritis and recent prednisone dose >11 mg/day were significant risk factors for disseminated TB which is associated with poor prognosis.
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