Research Article
Volume 10 Issue 5 - 2021
Prevalence and Predictive Clinical-Laboratory Parameters of Latent Tuberculosis in Rheumatoid Arthritis - A Retrospective Clinicopathologic Study of 161 Autopsy Patients
Ágnes Apáthy1 and Miklós Bély2*
1Department of Rheumatology, St. Margaret Clinic Budapest, Hungary
2Department of Pathology, Hospital of the Order of the Brothers of Saint John of God in Budapest, Hungary
*Corresponding Author: Miklós Bély, Department of Pathology, Hospital of the Order of the Brothers of Saint John of God in Budapest, Hungary.
Received: January 25, 2021; Published: April 30, 2021


Introduction: The risk of latent, clinically not diagnosed tuberculosis is high in rheumatoid arthritis. Recognition of indolent tuberculosis is of great importance especially before starting immunosuppressive or biological therapy for rheumatoid arthritis.

Aim: The aim of this study was to determine the classic clinical-laboratory parameters associated with post-primary inactive fibrous or fibrocaseous tuberculosis, with or without active miliary dissemination of tuberculosis in rheumatoid arthritis.

Patients and Methods: A non-selected autopsy population of 161 in-patients with rheumatoid arthritis was studied.

Rheumatoid arthritis was confirmed clinically according to the criteria of the American College of Rheumatology.

The post-primary fibrous, fibrocaseous or miliary disseminated tuberculosis was diagnosed at autopsy, confirmed and characterized microscopically by a detailed review of extensive histological material, reviewing all the available clinical and pathological reports retrospectively.

Clinical-laboratory parameters of different patient cohorts were compared with the Student (Welch) t-probe.

Results: Post-primary tuberculosis was associated with rheumatoid arthritis in 21 (13.04%) of 161 patients.

Post-primary tuberculosis was localized to the lungs.

Twelve (57.14%) of 21 tuberculosis were histologically only fibrous, antracothic tuberculotic scars and 9 (42.86%) of 21 revealed a fibrocaseous tubercle.

One of 12 fibrous and 5 of 9 fibrocaseous tuberculosis were complicated by miliary dissemination in 6 (3.72% of 161; 28.57% of 21) rheumatoid arthritis patients.

Eleven of 12 fibrous and 4 of 9 fibrocaseous tuberculosis were inactive (not complicated by miliary dissemination) in 15 (9.31% of 161; 71.43% of 21) patients.

There was no significant difference in most of the clinical laboratory parameters between patient cohorts with fibrous, fibrocaseous or miliary tuberculosis and without tuberculosis.

In fibrocaseous or miliary tuberculosis the total albumin and globulin levels of the blood decreased significantly; the albumin/ globulin ratio was less than “1” (in contrast to the normal value which is more than “1”).

The proportion of α 1 and α 2 globulin % was significantly higher in rheumatoid arthritis patients with fibrocaseous or miliary tuberculosis in comparison without tuberculosis.

Discussion and Conclusions: Men and women could be affected by fibrous, fibrocaseous or miliary tuberculosis at any time during rheumatoid arthritis.

The onset and duration of rheumatoid arthritis in patient cohorts did not influence the prevalence and features of coexistent fibrous, fibrocaseous or miliary tuberculosis.

The significant and consequent decrease of albumin/ globulin quotient and elevated α 1 and α 2 globulin % in elderly patients with moderate clinical activity of rheumatoid arthritis may indicate the reactivation of dormant inactive tuberculotic processes, excluding other causes of actual inflammatory activity (for example attenuated or subclinical septic infection, rheumatoid vasculitis, inflammatory AA amyloidosis, etc.).

This tendency of the aforementioned laboratory parameters in patient cohorts with fibrocaseous or miliary tuberculosis, especially elderly women with moderate clinical activity of rheumatoid arthritis should warn the physicians of indolent tuberculosis, excluding other reasons of increased inflammatory activity.


Keywords: Rheumatoid Arthritis; Latent Inactive and Active Tuberculosis; Clinical-Laboratory Parameters


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Citation: Ágnes Apáthy and Miklós Bély. “Prevalence and Predictive Clinical-Laboratory Parameters of Latent Tuberculosis in Rheumatoid Arthritis - A Retrospective Clinicopathologic Study of 161 Autopsy Patients”. EC Pulmonology and Respiratory Medicine 10.5 (2021): 76-89.

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