Prevalence of Latent Tuberculosis Infection (LTBI) in Mexican Patients With Rheumatoid Arthritis (RA)

Abel Eduardo Zavala Del Ángel; Jaime Morales-Romero; Roberto Zenteno-Cuevas; José Antonio Enciso Moreno; María Del Pilar Mata Miranda; Jorge Luis Martínez Zapata; Clara Luz Sampieri Ramírez; María Gabriela Nachón García; María Sobeida Leticia Blázquez Morales; María Teresa Álvarez-Bañuelos; José Artemio Cruz López; Verónica Patricia Demeneghi-Marini; Laura González-López; Jorge Iván Gámez-Nava

doi:10.7759/cureus.39743

Prevalence of Latent Tuberculosis Infection (LTBI) in Mexican Patients With Rheumatoid Arthritis (RA)

Cureus. 2023 May 30;15(5):e39743. doi: 10.7759/cureus.39743. eCollection 2023 May.

Authors

Abel Eduardo Zavala Del Ángel¹, Jaime Morales-Romero², Roberto Zenteno-Cuevas², José Antonio Enciso Moreno³, María Del Pilar Mata Miranda⁴, Jorge Luis Martínez Zapata⁵, Clara Luz Sampieri Ramírez², María Gabriela Nachón García¹, María Sobeida Leticia Blázquez Morales¹, María Teresa Álvarez-Bañuelos², José Artemio Cruz López⁶, Verónica Patricia Demeneghi-Marini⁴, Laura González-López⁷, Jorge Iván Gámez-Nava⁷

Affiliations

¹ Health Sciences Institute, Universidad Veracruzana, Xalapa, MEX.
² Public Health Institute, Universidad Veracruzana, Xalapa, MEX.
³ Biomedical Sciences, Instituto Mexicano del Seguro Social, Zacatecas, MEX.
⁴ Family Medicine Unit No. 66, Instituto Mexicano del Seguro Social, Xalapa, MEX.
⁵ Rheumatology and Internal Medicine, Instituto Mexicano del Seguro Social, Xalapa, MEX.
⁶ Public Health Coordination, Regional Decentralized Administrative Operation Organ Veracruz-Norte, Instituto Mexicano del Seguro Social, Xalapa, MEX.
⁷ University Center of Health Sciences, Universidad de Guadalajara, Guadalajara, MEX.

Abstract

Introduction: Patients with rheumatoid arthritis (RA) are at increased risk of developing tuberculosis, and even more so if they receive biological agents. In Mexico, the prevalence of latent tuberculosis infection (LTBI) in RA diagnosed by interferon-gamma release assay (IGRA) is largely unknown. The objective was to determine LTBI prevalence and the associated risk factors in rheumatoid arthritis patients.

Methods: A cross-sectional study was performed comprising 82 patients with RA who attended the rheumatology service at a second-level hospital. Demographic characteristics, comorbidity, Bacillus Calmette-Guerin (BCG) vaccination and smoking history, type of treatment, disease activity and functional capacity were investigated. The Disease Activity Score 28 and the Health Assessment Questionnaire-Disability Index were applied for the estimate of RA activity and functional capacity. Further information was compiled from the electronic medical records and personal interviews. LTBI was determined by QuantiFERON TB Gold Plus (QIAGEN, Germantown, USA).

Results: Prevalence of LTBI was 14% (95% confidence interval (CI): 8.6% to 23.9%). Factors associated with LTBI were history of smoking (odds ratio (OR) = 6.63 95% CI 1.01 to 43.3) and disability score (OR = 7.19 95%CI 1.41 to 36.6).

Conclusions: The prevalence of LTBI in Mexican patients with RA was 14%. Our results suggest prevention of smoking and functional incapacity could reduce the risk of LTBI. Further research could endorse our results.

Keywords: igra; interferon-gamma release tests; latent tuberculosis infection; prevalence; rheumatoid arthriitis; risk factors.

Grants and funding

First author, Abel Eduardo Zavala del Ángel, received a scholarship (number 486554) from the National Council of Science and Technology (CONACYT, Mexico). The General Directorate of Investigations of the Universidad Veracruzana supported by paying the transportation service of the plasma samples.