Tuberculosis Among Patients With Systemic Lupus Erythematosus in Indonesia: A Cohort Study

Tuberculosis incidence and mortality are high in SLE patients in Indonesia. This study showed risk factors are methylprednisolone pulse, age <= 25 at SLE diagnosis, and tuberculosis household contact. SLE patients in tuberculosis-endemic settings may benefit from tuberculosis preventive therapy. Background In previous studies, researchers have identified systemic lupus erythematosus (SLE) as a risk factor for tuberculosis (TB), but data from TB-endemic countries are still relatively scarce. We examined TB in a large cohort of SLE patients in Indonesia. Methods All patients registered in a lupus registry of the top referral hospital for West Java between 2008 and 2020 were included. Data on SLE characteristics and treatment were retrieved from the registry, and data on TB diagnosis, localization, and outcome were extracted from medical records. Cox-proportional hazard model was used to examine risk factors for development of TB. Results Among 1278 SLE patients observed over a total of 4804 patient-years, 131 patients experienced 138 episodes of TB, a median of 2 years (interquartile range, 0.6-5.4) after diagnosis of SLE. A total of 113 patients (81.9%) had pulmonary involvement and 61 (44.2%) had extrapulmonary involvement, with disseminated disease in 26 of 138 episodes (18.8%), and 13 of 131 patients (9.9%) died from TB. The estimated TB incidence was 2873 cases per 100 000 person years. In multivariate cox regression analysis, development of TB was associated with household TB contact (hazard ratio [HR], 7.20; 95% confidence interval [CI], 4.05-12.80), pulse methylprednisolone therapy (HR, 1.64; 95% CI, 1.01-2.67), and age <= 25 years old at SLE diagnosis (HR, 1.54; 95% CI, 1.00-2.35). Conclusions There is a high burden of TB in SLE patients in this TB-endemic setting, underlining the need for evaluation or implementation of TB preventive strategies.