The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical characteristics and prognostic factors of non-tuberculous mycobacterial disease in patients with rheumatoid arthritis

  • Hyemin Kim (Department of Rheumatology, Ajou University School of Medicine) ;
  • Soyoung Lee (Department of Rheumatology, Ajou University School of Medicine) ;
  • Ji-Won Kim (Department of Rheumatology, Ajou University School of Medicine) ;
  • Ju-Yang Jung (Department of Rheumatology, Ajou University School of Medicine) ;
  • Chang-Hee Suh (Department of Rheumatology, Ajou University School of Medicine) ;
  • Hyoun-Ah Kim (Department of Rheumatology, Ajou University School of Medicine)
  • Received : 2023.04.27
  • Accepted : 2023.06.19
  • Published : 2024.01.01
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Abstract

Background/Aims: This study aimed to identify the clinical characteristics of patients with concurrent rheumatoid arthritis (RA) and suspected non-tuberculous mycobacterial (NTM) infections as well as determine their prognostic factors. Methods: We retrospectively reviewed the medical records of 91 patients with RA whose computed tomography (CT) findings suggested NTM infection. Subsequently, we compared the clinical characteristics between patients with and without clinical or radiological exacerbation of NTM-pulmonary disease (PD) and investigated the risk factors for the exacerbation and associated mortality. Results: The mean age of patients with RA and suspected NTM-PD was 65.0 ± 10.2 years. The nodular/bronchiectatic (NB) form of NTM-PD was the predominant radiographic feature (78.0%). During follow-up, 36 patients (41.9%) experienced a radiological or clinical exacerbation of NTM-PD, whereas 12 patients (13.2%) died. Combined interstitial lung disease (ILD), microbiologically confirmed NTM-PD, and NB with the fibrocavitary (FC) form on chest CT were identified as risk factors for the clinical or radiological exacerbation of NTM-PD. Hydroxychloroquine use was identified as a good prognostic factor. Conversely, history of tuberculosis, ILD, smoking, microbiologically confirmed NTM-PD, and NB with the FC form on chest CT were identified as poor prognostic factors for mortality in suspected NTM-PD. Conclusions: ILD and NB with the FC form on chest CT were associated with NTM-PD exacerbation and mortality. Hydroxychloroquine use may lower the risk of NTM-PD exacerbation. Therefore, radiographic features and presence of ILD should be considered when predicting the prognosis of patients with RA and suspected NTM-PD.

Keywords

Acknowledgement

We would like to express our gratitude to Dr. Sun-Kyung Lee for assisting us with data management and statistical analysis. Additionally, we acknowledge the assistance of ChatGPT in English language editing during the manuscript revision process.

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