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Active tuberculosis infection in moroccan patients with rheumatic diseases under biologic therapy: A multicenter national study
Ilham Aachari1, Latifa Tahiri1, Gehan Elolemy2, Fatima Z Taik1, Saloua Afilal1, Safaa Fellous1, Jihad M Berkchi1, Hanan Rkain3, Rachid Bahiri4, Abderrahim Majjad5, Lahsen Achemlal5, Soumaya Ousehal6, Kawtar Nassar6, Ouafa Mkinsi6, Fatima Z Mahha7, Asmae El Aissaoui7, Imane Chaoui7, Taoufik Harzy7, Tarik Youssoufi8, Hasna Hassikou8, Anass Kherrab9, Radouane Niamane9, Jalila Eddarami10, Linda Ichchou10, Imad Ghozlani11, Imane El Bouchti12, Fatima Z Abourazzak13, Rachid Razine14, Fadoua Allali1
1 Department of Rheumatology B, El Ayachi Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
2 Department of Rheumatology, Faculty of Medicine, Benha University, Banha, Egypt
3 Department of Rheumatology B, El Ayachi Hospital, Faculty of Medicine and Pharmacy, Mohammed V University; Laboratory of Physiology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
4 Department of Rheumatology A, El Ayachi Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
5 Department of Rheumatology, Mohammed V Military Hospital, Rabat, Morocco
6 Department of Rheumatology, CHU Ibn Rochd, Casablanca, Morocco
7 Department of Rheumatology, CHU Hassan II, Fez, Morocco
8 Department of Rheumatology, Moulay Ismail Military Hospital, Meknes, Morocco
9 Department of Rheumatology, Avicenne Military Hospital, Marrakech, Morocco
10 Department of Rheumatology, CHU, Oujda, Morocco
11 Department of Rheumatology, First Medical and Surgical Center, Agadir, Morocco
12 Department of Rheumatology, Arrazi Hospital, CHU Mohammed VI, Marrakech, Morocco
13 Department of Rheumatology, CHU, Tangier, Morocco
14 Department of Public Health Laboratory, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
Correspondence Address:
Ilham Aachari
Department of Rheumatology B, El Ayachi Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Impasse Souissi, Rabat 10100
Morocco
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijmy.ijmy_153_20
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Background: The aim of this study was to evaluate the prevalence of active tuberculosis (TB) infection in Moroccan patients with rheumatic diseases under biologic therapy, and to describe the demographic characteristics of these patients as well as to explore potential risk factors. Methods: This 14-year nationally representative multicenter study enrolled Moroccan patients with rheumatic diseases who had been treated with biologic therapy. Patient medical records were reviewed retrospectively for demographic characteristics, underlying rheumatic diseases, associated comorbidities, and TB-related data. Results: In total, 1407 eligible patients were studied, detailed records were obtained for only 130 patients; 33 cases with active TB were identified at an estimated prevalence rate of 2.3%. The mean age was 42.9 ± 12 years and 75.8% were males. Ankylosing spondylitis accounted for 84.8% of active TB cases, and the majority of the cases (31/33) occurred among antitumor necrosis factor-alpha (TNF-α) users. A total of 8 out of 33 patients were positive at initial latent TB infection (LTBI) screening by tuberculin skin test and/or interferon-gamma release assay. Consumption of unpasteurized dairy products (odds ratio [OR], 34.841; 95% confidence interval [CI], 3.1–389.7; P = 0.04), diabetes (OR, 38.468; 95% CI, 1.6–878.3; P = 0,022), smoking (OR, 3.941; 95% CI, 1–159.9; P = 0.047), and long biologic therapy duration (OR, 1.991; 95% CI, 1.4–16.3; P = 0.001) were identified as risk factors for developing active TB. Conclusion: Moroccan patients with rheumatic diseases under anti-TNF-α agents are at an increased TB risk, especially when risk factors are present. Strict initial screening and regular monitoring of LTBI is recommended for patients living in high TB prevalence areas.
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