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Tuberculosis in Turkish patients with systemic lupus erythematosus: increased frequency of extrapulmonary localization

Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey, sayarli{at}hotmail.com

M Inanc

Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

S Kamali

Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

A Cefle

Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

O Karaman

Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

A Gul

Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

L Ocal

Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

O Aral

Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

M Konice

Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey

The objectivewas to investigatethe frequencyand characteristicsof tuberculosis(TB) in patients with systemic lupus erythematosus (SLE). We reviewed the charts of 556 patients with SLE who were followed up between 1978 and 2001 in our lupus clinic. Patientswho developedTB after the diagnosis of SLE were identified (SLE/TB). Ninety-six consecutive patients with SLE who did not develop TB during the follow-up were evaluated as a control group (SLE/TB^-). Clinical, laboratory and management characteristics of these two groups of patients were recorded according to a predefined protocol, and compared. Of the 556 patients evaluated, 20 patients (3.6%) with TB were identified. Nine of the 20 patients (45%) had extrapulmonary TB (vertebral involvement in three patients, meningeal in two, and joint and soft tissue in four). Arthritis and renal involvement were significantly high in the SLE/TB group (P 0.045, P 0.009, respectively). The mean daily dose of prednisolonebefore the diagnosis of TB and the cumulative dose of prednisolonewere significantly higher in the SLE/TB group compared to the SLE/TB^- group (27 + 22 g versus 16 + 16 g, 24 + 45 mg versus 11 + 8.5 mg, respectively). In conclusion, we found an increased frequency of TB infection and a high prevalence of extrapulmonary TB in a large cohort of SLE patients. The mean daily dose of prednisolonebefore the diagnosisof TB and the cumulativedose of prednisolone, which possibly related to disease severity, were important determinants for the increased risk of TB in these patients with SLE.

Key Words: systemic lupus erythematosus • tuberculosis

Lupus, Vol. 13, No. 4, 274-278 (2004)
DOI: 10.1191/0961203303lu529xx


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