Tuberculosis in myasthenia gravis
OBJECTIVE: To evaluate the relationship between MG and TB.
DESIGN: A national survey conducted between 2000 and 2006 included 2317 patients with MG identified from the Taiwan National Health Insurance database. The incidence rate ratio of TB in these patients was compared with those in 23 170 randomly selected age-, sex- and comorbidity-matched controls without MG.
RESULTS: The risk of TB was higher in the MG cohort (adjusted hazard ratio [aHR] 1.96, 95% confidence interval [CI] 1.22–3.16, P = 0.005), mainly due to an excess risk of pulmonary TB (aHR 2.10, 95%CI 1.27–3.47, P = 0.004). Age ≥60 years (HR 4.99, 95%CI 2.06–12.10, P < 0.001) and the use of corticosteroids (HR 1.12, 95%CI 1.07–1.17, P < 0.001) were risk factors for developing TB in the MG cohort. Patients with MG who developed TB had a lower 5-year survival rate than those who did not (89.4% vs. 96.0%, P = 0.032).
CONCLUSION: The incidence of pulmonary TB is significantly higher in patients with MG. Careful screening strategies for TB should be considered among high-risk patients with MG.
Keywords: autoimmune diseases; extra-pulmonary tuberculosis; glucocorticoids; myasthenia gravis; pulmonary tuberculosis
Document Type: Research Article
Affiliations: 1: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 2: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan 3: School of Medicine, National Yang-Ming University, Taipei, Taiwan; and Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 4: School of Medicine, National Yang-Ming University, Taipei, Taiwan; and Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan 5: Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan 6: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 7: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan 8: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, and Brain Research Center, National Yang-Ming University, Taipei, Taiwan
Publication date: 01 January 2013
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