Rheumatoid Arthritis, Its Treatments, and the Risk of Tuberculosis in Quebec, Canada
Rheumatoid Arthritis, Its Treatments, and the Risk of Tuberculosis in Quebec, Canada
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DOI：
10.1002/art.24476
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发表时间：
2009-03-15
期刊：
影响因子：
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通讯作者：
Suissa, Samy
中科院分区：
文献类型：
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作者：
Brassard, Paul;Lowe, Anne-Marie;Suissa, Samy
Objective.确定魁北克类风湿性关节炎（RA）患者队列中结核病（TB）的风险，并评估该风险是否与暴露于非生物疾病缓解抗风湿药物（DMARDs）相关。我们研究了一组从1980-2003年魁北克省医生账单和住院数据库中确定的RA患者。确定了1992-2003年期间的结核病发病率，并使用标准化发病率比（SIR）将其与年龄和性别标准化的一般人群进行了比较。在巢式病例对照分析中使用条件Logistic回归来估计索引日期前一年中与非生物性DMARD暴露相关的TB的率比（RR）。在队列中的24，282例RA患者中，确定了50例结核病病例。标准化发病率为45.8例/100，000人-年，相比之下，魁北克一般人群中为4.2例/100，000人-年（SIR 10.9，95%置信区间[95%CI] 7.9-15.0）。糖皮质激素治疗组和非生物制剂DMARD治疗组TB的校正RR分别为2.4（95%CI 1.1-5.4）和3.0（95%CI 1.6-5.8）。RA患者的结核病年龄和性别标准化发病率是普通人群的10倍。至少部分风险可能与非生物性DMARD和皮质类固醇治疗有关。我们的数据支持在开始任何免疫抑制治疗前进行结核病筛查的作用。
Objective. To determine the risk of tuberculosis (TB) among a cohort of patients with rheumatoid arthritis (RA) in Quebec and assess whether this risk is associated with exposure to nonbiologic disease-modifying antirheumatic drugs (DMARDs).Methods. We studied a cohort of patients with RA identified from the Quebec provincial physician billing and hospitalization databases for 1980-2003. TB incidence rates were determined for the period 1992-2003 and compared with the general population, standardized for age and sex using the standardized incidence ratio (SIR). Conditional logistic regression was used in a nested case-control analysis to estimate the rate ratio (RR) of TB related to nonbiologic DMARD exposure during the year before the index date.Results. Of the 24,282 patients with RA in the cohort, 50 cases of TB were identified. The standardized incidence rate was 45.8 cases per 100,000 person-years compared with 4.2 cases per 100,000 person-years in the general population of Quebec (SIR 10.9, 95% confidence interval [95% CI] 7.9-15.0). The adjusted RR of TB was 2.4 (95% CI 1.1-5.4) with corticosteroid use and 3.0 (95% CI 1.6-5.8) with nonbiologic DMARD use.Conclusion. The age- and sex-standardized incidence rate of TB in RA patients is 10 times that of the general population. At least some of this risk may be related to nonbiologic DMARD and corticosteroid therapies. Our data support the role of TB screening before initiation of any immunosuppressive therapy.