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MR Vol.14 No.2 indexに戻る
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MODERN RHEUMATOLOGY
Vol.14 No.2 |
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Clinical characteristics of Mycobacterium tuberculosis
infection among rheumatoid arthritis patients
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| Yasuhiko Yoshinaga1, 3 , Tatsuya Kanamori1, Yusuke
Ota1, Tomoko Miyoshi2, Hidetoshi Kagawa1 and Masahiro Yamamura2 |
(1) Department of Rheumatology, National Minami-Okayama
Hospital, 4066 Hayashima, Hayashima-cho, Tsukubo-gun, Okayama,
701-0304, Japan
(2) Department of Medicine and Clinical Science, Okayama University Graduate
School of Medicine and Dentistry, Okayama, Japan
(3) Present address: Rheumatic Disease Center, Kurashiki Medical Center, 250
Bakuro-cho, Kurashiki, 710-8522, Japan |
Received: 22 July 2003 Accepted: 27 December
2003 |
| Abstract |
| To evaluate the clinical characteristics of
Mycobacterium tuberculosis infection in rheumatoid arthritis (RA)
patients, we
examined the clinical manifestations and radiography/computed tomography
(CT) findings in RA patients with tuberculosis (RA+/TB+). A total
of 1121 tuberculosis patients were admitted to our hospital from
1995 to 2003, with the RA patients among them comprising 1.8% (20
cases; 9 men and 11 women). This is approximately three times as
high as the prevalence of RA in the entire population in Japan. In
addition, the RA+/TB+ patients were older and had a longer history
of RA than the 140 outpatients in our RA clinic who did not have
tuberculosis (RA+/TB?). Half of the RA+/TB+ patients had no symptoms
(e.g., cough, sputum, pyrexia), and their tuber-culosis was detected
accidentally by radiography/CT. The positive rates of the bacilli
in the smear and culture of the sputum from the RA+/TB+ patients
were lower than those from 143 patients randomly selected from among
1091 tuberculosis patients without any collagen disease including
RA (RA?/TB+). The RA+/TB+ patients had a higher incidence of extrapulmonary
tuberculosis (30%), including four cases (20%) of miliary tuberculosis,
an incidence seven times higher than among the general population
of tuberculosis patients. Among 14 cases of pulmonary tuberculosis
patients with RA, bilateral lesions and noncavitary lesions were
found in 71.4% and 64.3%, respectively, which tended to be a higher
incidence than in the RA?/TB+ patients. The mortality rate and sputum
conversion time of the RA+/TB+ patients were no different from those
of the RA?/TB+ patients. The prevalence of tuberculosis in RA patients
is expected to increase after introduction of anticytokine therapy
in Japan, and careful observation should be done to avoid this complication
in RA patients. |
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| Key words |
| Extrapulmonary tuberculosis - Miliary tuberculosis
- Mycobacterium tuberculosis - Rheumatoid arthritis (RA) |
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