Risk factors and prevalence of latent tuberculosis infection in rheumatic patients: a meta-analysis

This study aims to evaluate the risk factors and prevalence of latent tuberculosis infection (LTBI) in patients with rheumatic diseases. Databases including PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Vip, and Wanfang were searched. Data extraction was performed independently by two authors. The Newcastle-Ottawa Scale (NOS) was utilized to assess study quality. Heterogeneity was evaluated using I2 statistics and the chi-square test. The relative risk (RR), odds ratio (OR) with 95% confidence intervals (95% CI), and prevalence rate were calculated. Sensitivity analysis was conducted using the leave-one-out method. Publication bias was assessed using either the Begg rank correlation or Egger’s linear regression. Eighteen studies (13 cross-sectional and 5 cohort studies) involving 12,167 rheumatic patients were included. Increased risk of LTBI was associated with current smoking (OR = 1.50, 95%CI: 1.28–1.78), Golimumab treatment (OR = 2.90, 95% CI: 1.08–7.78), Chloroquine treatment ( OR = 1.27, 95% CI:1.01–1.61), age > 40 (OR = 1.84, 95% CI: 1.51–2.24) and a history of tuberculosis (TB) ( OR = 3.26, 95% CI: 1.87–5.68). Additionally, male rheumatic patients had a higher risk of LTBI compared to females (OR = 1.72, 95% CI: 1.46– 2.02). However, no significant associations were found between LTBI risk and history of smoking, duration of disease, history of Bacillus Calmette-Guérin, positive rheumatoid factor, corticosteroid use, diabetes history, TB exposure, Adalimumab or Etanercept use. The pooled prevalence rate of LTBI in rheumatic patients was 22% (95% CI: 18–27%). Current smoking, Golimumab treatment, Chloroquine treatment, age >40 and a history of TB are identified as risk factors for LTBI in rheumatic patients. Male patients are more prone to developing LTBI. The overall LTBI prevalence in rheumatic patients is high.