Risk of Tuberculosis in Children with Juvenile Idiopathic Arthritis: A Nationwide Population-Based Study in Taiwan

• Published in: PloS one 2015-06, Vol.10 (6), p.e0128768-e0128768
• Main Authors: Hsin, Yi-Chen, Zhuang, Lai-Zhen, Yeh, Kuo-Wei, Chang, Cheng-Wei, Horng, Jorng-Tzong, Huang, Jing-Long
• Format: Article
• Language: English
• Subjects: Adolescent; Age; Antirheumatic Agents - therapeutic use; Arthritis; Arthritis, Juvenile - complications; Arthritis, Juvenile - drug therapy; Arthritis, Juvenile - epidemiology; Arthritis, Juvenile - immunology; Case-Control Studies; Child; Child, Preschool; Children; Codes; Computer science; Data processing; Databases, Factual; Development and progression; Etanercept - therapeutic use; Female; Gender; Hospitals; Humans; Immunology; Incidence; Infant; Infections; Infliximab - therapeutic use; Inhibitors; Male; Methotrexate; Methotrexate - therapeutic use; National health insurance; Nonsteroidal anti-inflammatory drugs; Online databases; Patients; Pediatrics; Pharmacy; Population; Population studies; Population-based studies; Proportional Hazards Models; Quality of life; Regression analysis; Regression models; Rheumatoid arthritis; Rheumatology; Risk; Studies; Taiwan - epidemiology; TNF inhibitors; Tuberculosis; Tuberculosis, Pulmonary - complications; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - immunology; Tumor necrosis factor; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0128768

We aimed to determine the risk of tuberculosis in children with juvenile idiopathic arthritis (JIA) in Taiwan. We used the Taiwan National Health Insurance Research Database (NHIRD) to conduct a nested case-control study. We identified a JIA cohort and matched each JIA child with non-JIA children for comparison. Methotrexate (MTX), tumor necrosis factor (TNF) inhibitor administration, and new tuberculosis cases were determined during our study period. To compare tuberculosis (TB) risk among our study groups, Cox proportional regression models were used to determine adjusted hazard ratios (aHRs). We identified 1495 children with JIA and 11592 non-JIA children. Majority (68.7%) children with JIA had not received MTX or TNF inhibitors; 23.9% used MTX without TNF inhibitors, and 7.4% received TNF inhibitors, irrespective of MTX administration. In total, 43 children developed tuberculosis. The overall tuberculosis infection rate for children with JIA was two times higher than that for non-JIA children. Compared with non-JIA children, children with JIA who used MTX without TNF inhibitors revealed a significantly increased of tuberculosis infection rate (aHR = 4.67; 95% CI: 1.65-13.17; P = 0.004). Children with JIA who either received TNF inhibitors or never used MTX and TNF inhibitors revealed a tuberculosis infection rate comparable to that of non-JIA children. Analysis of nationwide data of Taiwan suggested that children with JIA were at higher risk of tuberculosis compared with those without JIA.