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Severe psoriasis might be related to greater risk for tuberculosis
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Patients with severe psoriasis appear to have an increased risk for developing tuberculosis, according to study results.
Researchers used the National Health Insurance Research Database of Taiwan to study the risk for active tuberculosis (TB) among 81,266 patients with psoriasis or psoriatic arthritis (mean age, 44.1 years; 61% men) but without a history of TB or anti-TB drug use from 1996 to 2008. The mean follow-up was 5.98 years.
After being matched for age and gender, standardized incidence rates for TB were evaluated and compared against the general population. The odds ratio of TB related to exposure to traditional systemic agents during the year before disease development was estimated by using a nested case-control analysis.
Four hundred ninety-seven new active cases of TB were identified, with an incidence rate among psoriasis patients of 102 cases per 100,000 person-years (standardized incidence ratio [SIR]=1.22; 95% CI, 1.18-1.33). Patients with severe psoriasis had a greater TB risk (SIR=1.52; 95% CI, 1.46-1.74).
A nested-case control analysis was conducted within the psoriasis cohort, with 1,988 patients randomly selected as matched controls with the active TB patients.
“Patients taking systemic corticosteroids and nonsteroidal anti-inflammatory drugs were associated with higher incidence of TB, especially frequent users, after adjustment for multiple TB risk factors, drug exposures, hospital visits and level of urbanization,” the researchers said.
Similar results were reported by stratified analyses of current users and new users of the drugs. No associations between TB and traditional systemic antipsoriatic treatment were observed.
“Severe psoriasis may be associated with elevated TB risk,” the researchers concluded. “Use of traditional systemic antipsoriatic drugs does not seem to be strongly associated with TB in patients with psoriasis or psoriatic arthritis.”
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