In a major new study of over 350,000 individuals, researchers have uncovered compelling evidence that patients with rheumatoid arthritis face a significantly higher risk of developing active pulmonary tuberculosis, even in modern healthcare settings where tuberculosis screening precedes biologic treatment.
The study examined 59,577 people with rheumatoid arthritis (RA), 41,501 of whom were seropositive and 18,076 seronegative, and compared them to 297,885 age- and sex-matched controls without RA. The cohort was tracked from 2010 to 2019, with a median follow-up period of 4.4 years following a one-year lag to ensure new cases were captured.
After adjusting for potential confounders, the findings showed that patients with RA were 3.2 times more likely to develop active pulmonary tuberculosis than controls. The risk was particularly elevated among seropositive patients, who had a 3.20-fold increase in TB risk, while seronegative patients exhibited a 2.54-fold rise compared to controls.
Strikingly, patients treated with biological or targeted synthetic disease-modifying antirheumatic drugs (DMARDs) had a 4.68-fold increased risk of active TB, compared to the general population. Even those not exposed to these advanced therapies showed a 2.88-fold higher risk.
The data also highlighted key risk factors for TB among RA patients, including male sex, low body weight, and comorbidities such as diabetes mellitus.
These findings suggest that current TB screening strategies may not fully mitigate the infection risk in this vulnerable population. The authors propose that more tailored TB surveillance may be necessary, especially for seropositive RA patients and those undergoing treatment with DMARDs.
This study adds urgency to the discussion about long-term infection monitoring protocols in autoimmune disease management and calls for heightened vigilance among clinicians caring for patients with RA.
Reference:
Choi H et al. Impact of seropositivity and disease-modifying antirheumatic drugs on pulmonary tuberculosis risk in rheumatoid arthritis. ERJ Open Res. 2025;11(3):00957-2024.
