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Tuberculosis infection in primary Sjögren’s syndrome: a nationwide population-based study

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Abstract

Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease and may complicate with interstitial lung disease. The risk of Mycobacterium tuberculosis (TB) infection in patients with pSS has not been determined. This nationwide population-based study aimed to explore the incidence and risk factors of TB infection in patients with pSS. We identified 4,822 pSS patients from the Taiwan National Health Insurance database and compared the incidence rates of TB infection in these patients with 48,220 randomly selected age-, sex-, and comorbidity-matched subjects without pSS. The Cox proportional hazard model was used to identify risk factors for TB in patients with pSS. The risk of TB was higher in the pSS cohort than in the control cohort with an incidence rate ratio (IRR) of 1.58 (95 % confidence interval [95 % CI] 1.13–2.18, p = 0.006). The risk factors for TB in the pSS cohort were age ≥60 years (hazard ratio [HR] 3.22, 95 % CI 1.78–5.84; p < 0.001), and corticosteroid usage, which had a dose-dependent effect in the pSS patients compared to the nonusers (daily prednisolone dose or equivalent less than 5 mg/day: HR 2.34; p = 0.020, 95 % CI 1.14–4.78; 5 mg/day to less than 10 mg/day: HR 4.79, 95 % CI 2.15–10.68; p < 0.001; 10 mg/day or more: HR 12.19, 95 % CI 4.42–33.63; p < 0.001). Patients with pSS had a higher risk of pulmonary TB in Taiwan, which was related to age ≥60 years and corticosteroid usage.

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Acknowledgments

All authors acknowledge Miss Yeh Chiu-Mei for providing statistical consultation and assistance. This study is supported by a grant from Taipei Veterans General Hospital (V101D-001-2). The study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, and managed by National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or National Health Research Institutes.

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Authors and Affiliations

  1. Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan, Republic of China

    Chung-Tei Chou

  2. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan

    Yu-Sheng Chang, Shou-Ming Ou, Yu-Wen Hu, Tzeng-Ji Chen, Hui-Ting Lee & Chung-Tei Chou

  3. Division of Hematology and Oncology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chia-Jen Liu

  4. Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Chia-Jen Liu

  5. Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Shou-Ming Ou

  6. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan

    Yu-Wen Hu

  7. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Tzeng-Ji Chen

  8. Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan

    Hui-Ting Lee

  9. Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

    Chi-Ching Chang

  10. School of Medicine, Taipei Medical University, Taipei, Taiwan

    Chi-Ching Chang

  11. Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Yu-Sheng Chang

Authors
  1. Yu-Sheng Chang
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  2. Chia-Jen Liu
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  3. Shou-Ming Ou
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  4. Yu-Wen Hu
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  5. Tzeng-Ji Chen
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  6. Hui-Ting Lee
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  7. Chi-Ching Chang
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  8. Chung-Tei Chou
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Corresponding author

Correspondence to Chung-Tei Chou.

Additional information

Y.-S. Chang and C.-J. Liu made equal contributions to this article.

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Chang, YS., Liu, CJ., Ou, SM. et al. Tuberculosis infection in primary Sjögren’s syndrome: a nationwide population-based study. Clin Rheumatol 33, 377–383 (2014). https://doi.org/10.1007/s10067-013-2408-y

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  • DOI: https://doi.org/10.1007/s10067-013-2408-y

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