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REVIEW article

Front. Immunol.
Sec. Microbial Immunology
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1494283
This article is part of the Research Topic Immune Response in Tuberculosis with Comorbidities or Coinfections View all 8 articles

Management of tuberculosis risk, screening and preventive therapy in chronic autoimmune arthritis patients undergoing biotechnological and targeted immunosuppressive agents

Provisionally accepted
Andrea Picchianti-Diamanti Andrea Picchianti-Diamanti 1Alessandra Aiello Alessandra Aiello 2Chiara De Lorenzo Chiara De Lorenzo 1Giovanni Battista Migliori Giovanni Battista Migliori 3Delia Goletti Delia Goletti 4*
  • 1 Department of Clinical and Molecular Medicine, "Sapienza" University, S. Andrea University Hospital, 00189, Rome, Lazio, Italy
  • 2 Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, 00149, Rome, Lazio, Italy
  • 3 Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Italy
  • 4 Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani (IRCCS), Rome, Italy

The final, formatted version of the article will be published soon.

    Tuberculosis (TB) is the leading cause of death in the world from an infectious disease. Its etiologic agent, the Mycobacterium tuberculosis (Mtb), is a slow-growing bacterium that has coexisted in humans for thousands of years. According to the World Health Organization, 10.6 million new cases of TB and over 1 million deaths were reported in 2022. It is widely recognized that patients affected by chronic autoimmune arthritis such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) have an increased incidence rate of TB disease compared to the general population. As conceivable, the risk is associated with age ≥65 years and is higher in endemic regions, but immunosuppressive therapy plays a pivotal role. Several systematic reviews have analysed the impact of anti-TNF-α agents on the risk of TB in patients with chronic autoimmune arthritis, as well as for other biological disease-modifying immunosuppressive anti-rheumatic drugs (bDMARDs) such as rituximab, abatacept, tocilizumab, ustekinumab, and secukinumab. However, the data are less robust compared to those available with TNF-α inhibitors. Conversely, data on anti-IL23 agents and JAK inhibitors (JAK-i), which have been more recently introduced for the treatment of RA and PsA/AS, are limited. TB screening and preventive therapy are recommended in Mtb-infected patients undergoing bDMARDs and targeted synthetic (ts)DMARDs. In this review, we evaluate the current evidence from randomized clinical trials, long-term extension studies, and real-life studies regarding the risk of TB in patients with RA, PsA, and AS treated with bDMARDs and tsDMARDs. According to the current evidence, TNF-α inhibitors carry the greatest risk of TB progression among bDMARDs and tsDMARDs, such as JAK inhibitors and anti-IL-6R agents. The management of TB screening and the updated preventive therapy are reported.

    Keywords: tuberculosis disease, TB infection, Rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Biologic DMARDs, JAK inhibitors, preventive therapy

    Received: 10 Sep 2024; Accepted: 06 Jan 2025.

    Copyright: © 2025 Picchianti-Diamanti, Aiello, De Lorenzo, Migliori and Goletti. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Delia Goletti, Translational Research Unit, National Institute for Infectious Diseases Lazzaro Spallanzani (IRCCS), Rome, Italy

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.