The strategy of diagnosis and treatment
of rheumatic immune diseases complicated with tuberculosis infection involves many aspects. The following is a comprehensive strategy of diagnosis and treatment:
I. Diagnostic Strategy
Screening high-risk groups
Patients
with rheumatic immune diseases are at high risk of tuberculosis infection, especially those who intend to use tumor necrosis factor inhibitors (TNFi), long-term use of moderate to high doses of glucocorticoids, immunosuppressants, or disease-modifying antirheumatic drugs (DMARDs) with moderate to high risk of causing tuberculosis activity.
Screening for latent Mycobacterium tuberculosis infection (LTBI) should be performed routinely
in these high-risk populations.
Detection method
Tuberculin skin test (TST): a test using purified protein derivative of tuberculin (PPD) as antigen. TST has been widely used in LTBI screening in China. An induration with a mean diameter of ≥ 10 mm is usually interpreted as positive, but in the immunosuppressed population, an induration with a mean diameter of ≥ 5 mm can be interpreted as positive.
Interferon-
gamma release assay (IGRA): It can detect the release of interferon-gamma in sensitized T lymphocytes after MTB antigen stimulation, so as to determine whether MTB infection exists in human body. The accuracy of IGRA is better than that of TST, suggesting that patients with rheumatic immune diseases should be preferentially screened for LTBI by IGRA.
Combined detection: In order to improve the accuracy of detection, TST and IGRA can be combined for screening.
Confirmed
The diagnosis of tuberculosis infection depends on bacteriological tests (such as smear, culture) and pathological tests (such as microscopic examination of the lesion site).
Imaging (such as X-ray, CT) combined with clinical signs and symptoms can also be diagnosed by clinicians.
II. Treatment Strategy
Prophylactic anti-tuberculosis treatment
Prophylactic antituberculous therapy should be considered
in patients with rheumatic immune disease with confirmed LTBI to reduce the risk of developing active tuberculosis.
Drugs and regimens
for prophylactic anti-TB therapy should be determined according to the patient’s specific condition and the doctor’s advice.
Treatment
of
active tuberculosis
Once patients with rheumatic immune diseases are diagnosed with active tuberculosis, anti-tuberculosis treatment should be carried out immediately.
Anti-tuberculosis treatment should follow the principles of early, combined, appropriate, regular and full course to ensure the therapeutic effect.
In the course of treatment, the patient’s condition and treatment response should be closely monitored, and the treatment plan should be adjusted in time.
Treatment
of rheumatic immune disease
At the same time of anti-tuberculosis treatment, the treatment of rheumatic immune diseases should not be neglected.
Appropriate drugs and regimens
should be selected to treat rheumatic immune diseases according to the specific conditions of patients and the advice of doctors.
In the course of treatment, we should pay attention to the interaction and adverse reactions between drugs, and adjust the treatment plan in time.
III. Precautions
Multidisciplinary collaboration
Rheumatic immune diseases complicated with tuberculosis infection require multidisciplinary collaboration in diagnosis and treatment, including rheumatic immunology, tuberculosis, respiratory and so on.
Communication and collaboration among
disciplines should be strengthened to develop individualized treatment programs.
Patient education
It is necessary to strengthen the education of patients and improve their understanding of tuberculosis infection and rheumatic immune diseases.
Inform patients of the importance and precautions of treatment, and encourage them to actively cooperate with the treatment.
Follow-up monitoring
Patients should be monitored
during and after treatment.
Evaluate the patient’s condition and treatment effect
regularly, and adjust the treatment plan in time.
To sum up, the diagnosis and treatment strategy of rheumatic immune diseases complicated with tuberculosis infection needs to take into account the specific conditions of patients and the advice of doctors. Through reasonable screening, diagnosis, treatment and follow-up monitoring, we can effectively control the disease and improve the survival rates.
