Tuberculosis Risk Assessment in Immune-Mediated Inflammatory Diseases

Immune-mediated inflammatory diseases (IMIDs), such as rheumatoid arthritis, psoriasis and inflammatory bowel disease, often necessitate therapies that modify or suppress key components of the immune system. While these treatments deliver major advances in symptom control and quality of life, they may also unmask or reactivate latent Mycobacterium tuberculosis infection (LTBI). Risk assessment in this context involves characterising individual susceptibility, balancing regional epidemiology and accounting for treatment regimen. Central to this endeavour are diagnostic algorithms that combine clinical history, radiology and immunodiagnostic tests to identify LTBI prior to initiation of biologic or targeted agents. A nuanced, risk-based strategy that considers age, comorbidity, epidemiological exposure and the immunosuppressive potency of drugs can inform decisions on prophylactic anti-tubercular therapy and ongoing surveillance. Advances in serological assays, three-dimensional in vitro models of granuloma formation and retrospective cohort analyses have enriched our understanding of host–pathogen interactions under immune modulation. Ultimately, integration of individual risk factors with evidence-based screening and prophylaxis protocols aims to prevent active tuberculosis while preserving the therapeutic benefits of immune-modifying treatments.

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Tuberculosis Risk Assessment in Immune-Mediated Inflammatory Diseases publication trend

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Technical terms

Latent tuberculosis infection (LTBI): State in which Mycobacterium tuberculosis resides in the host in a dormant form without causing active disease but with potential for reactivation, especially under immunosuppression.

Tumour necrosis factor alpha (TNFα) inhibitors: Biologic agents that neutralise TNFα, a cytokine critical for granuloma integrity and control of intracellular pathogens, thereby increasing the risk of mycobacterial reactivation.

Interferon-gamma release assay (IGRA): Blood test measuring T-cell release of interferon-gamma in response to M. tuberculosis antigens, used to detect LTBI with higher specificity than the tuberculin skin test.

Biologic therapies: Targeted protein or cell-based treatments designed to modulate specific components of the immune response in IMIDs, including monoclonal antibodies and receptor antagonists.

References

1. Regional risk of tuberculosis and viral hepatitis with tumor necrosis factor-alpha inhibitor treatment: A systematic review. Frontiers in Pharmacology (2023).
2. The risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: A 15-year real world experience in Taiwan. PLOS ONE (2017).
3. Different Risk of Tuberculosis and Efficacy of Isoniazid Prophylaxis in Rheumatoid Arthritis Patients with Biologic Therapy: A Nationwide Retrospective Cohort Study in Taiwan. PLOS ONE (2016).
4. TNF-α blockade impairs in vitro tuberculous granuloma formation and down modulate Th1, Th17 and Treg cytokines. PLOS ONE (2018).
5. Performance of the tuberculin skin test and interferon-γ release assay for detection of tuberculosis infection in immunocompromised patients in a BCG-vaccinated population. BMC Infectious Diseases (2009).