Rheumatoid Arthritis Significantly Increases Pulmonary TB Risk, Regardless of Treatment Status: Study Suggests

The research, led by Dr. Hayoung Choi from the Division of Pulmonary, Allergy, and Critical Care Medicine at Hallym University Kangnam Sacred Heart Hospital, underscores the continued need for vigilant TB surveillance in RA populations.

The nationwide study followed over 59,000 RA patients—subdivided into seropositive (SPRA) and seronegative (SNRA) groups—alongside nearly 298,000 matched controls without RA, over a period spanning up to nine years. Participants were tracked between 2010 and 2019, with a median follow-up duration of 4.4 years.

The key findings include the following:

• Individuals with rheumatoid arthritis (RA) had a 3.2-fold higher risk of developing active pulmonary tuberculosis (TB) compared to those without RA, even after adjusting for potential confounders.
• Seropositive RA patients exhibited a 3.2-fold increased TB risk compared to the general population.
• Seronegative RA patients showed a 2.5-fold higher risk of active pulmonary TB than matched controls.
• RA patients treated with biological or targeted synthetic DMARDs had a nearly 4.7-fold increased risk of developing active TB.
• RA patients not receiving these advanced therapies still had a 2.9-fold higher TB risk than the general population.
• The elevated TB risk in RA patients persisted regardless of exposure to DMARDs.
• Additional factors linked to increased TB susceptibility among RA patients included male sex, being underweight, and having comorbid conditions such as diabetes mellitus.

While the study stands out for its robust national dataset and comprehensive analysis of confounding variables, the authors acknowledged several limitations. For instance, data on individual TB infection screening outcomes and treatment completion were not available. Additionally, because the study population included individuals who had undergone health screenings, selection bias might have contributed to a relatively lower observed TB incidence. Moreover, the findings, derived from a country with an intermediate TB burden like South Korea, may not be directly generalizable to nations with lower or higher TB prevalence.

Despite these limitations, the research highlights a critical gap in TB prevention among RA patients. According to the authors, current TB infection screening and treatment protocols may not be sufficient to eliminate the risk of active disease, particularly in those on immunosuppressive therapies.

The authors concluded, "Given these insights, the study advocates for more tailored and intensified TB screening strategies in RA care—especially for patients with seropositive RA or those receiving biologics or targeted DMARDs."

Reference:

Choi H, Eun Y, Han K, Jung JH, Jung W, Kim H, Shin DW, Lee H. Impact of seropositivity and disease-modifying antirheumatic drugs on pulmonary tuberculosis risk in rheumatoid arthritis. ERJ Open Res. 2025 May 27;11(3):00957-2024. doi: 10.1183/23120541.00957-2024. PMID: 40432816; PMCID: PMC12107382.