Progression of tuberculosis among patients with rheumatic diseases – A systematic review and meta-analysis

Tuberculosis is a contagious disease that ranks among the top ten killers of humans worldwide. Mycobacterium tuberculosis is an etiological agent of tuberculosis. The prognosis of tuberculosis in patients with autoimmune diseases is high due to treatment with anti-TNF-alpha therapy. We analyzed the studies based on the Preferred Reporting Items and Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methods of eligibility criteria, search criteria and critical analyses, biased and challenges, and intervention. We observed the tuberculosis incidence of 595 (3.25%; 95% CI- 2.9 – 3.5) cases in systemic lupus erythematosus, 332 (4.54%; 95% CI - 4.07 - 5.01) in rheumatoid arthritis, and 25 (1.9%; 95% CI - 1.16 – 2.64) in multiple sclerosis out of 26,870 study populations in the various studies, and a total of 93 (7.2%; 95% CI - 5.8 – 8.6) cases in MS, and 10 (0.05%; 95% CI - 0.02 – 0.08) in SLE reported of TB indeterminate results. This systematic review comprehensively analyzed the recent studies of the disease progression of latent tuberculosis infection to active tuberculosis is high in treatments with glucocorticoid, azathioprine, prednisone, and leflunomide among patients with autoimmune diseases. We summarized recent studies emphasizing the risk factors of tuberculosis to be found the disease-modifying anti-rheumatic drug (DMARD), immunosuppressive treatments given to biologic-naive patients as the dominant factor associated with the risk of TB and treatment with a tumor necrosis factor inhibitor.