Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Outcome of Pulmonary NTM Disease in Patients with Underlying Rheumatic Disease:A Retrospective Observational Study.
Noh1, Jung Won, Hwang1, Jiwon, Lee1, Jaejoon, Ahn2, Joong Kyong, Jeon3, Chan Hong, Kim4, Jinseok, Koh1, Won-Jung
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Kangbuk Samsung hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
Soonchunhyang University College of Medicine, Bucheon, South Korea
Jeju National University Hospital, Jeju, South Korea
The existing data suggest that the incidence and prevalence of pulmonary nontuberculous mycobacteria (NTM) infections are increasing. However, the effect of rheumatic disease itself and immunosuppressive therapy on the clinical significance and the outcome of NTM pulmonary disease are unknown. This study was undertaken to evaluate the clinical significance and the outcome of pulmonary NTM disease in patients with underlying rheumatic disease.
We performed a retrospective analysis using medical records at a single tertiary hospital from January 2002 to January 2011. The patients with pulmonary NTM disease with underlying rheumatic disease were identified. The demographic data, underlying rheumatic diseases, immunosuppressive regimen, isolated NTM organism, treatment regimen for NTM disease, and culture negative conversion rate of NTM were analyzed.
A total of 24 patients with underlying rheumatic diseases who satisfied the criteria for pulmonary NTM disease as recommended by the American Thoracic Society were identified. Mean age was 60.9 ± 12.3 years and mean duration of follow up was 4.1 ± 3.2 years. The most common rheumatic disease was rheumatoid arthritis (58.3%), followed by systemic lupus erythematosus (8.3%), Sjogren's syndrome (8.3%), relapsing polychondritis (8.3%), ankylosing spondylitis (4.2%), mixed connective tissue disease (4.2%) and microscopic polyangiitis (4.2%). Immunosuppressive regimen included prednisolone (66.7%), methotrexate (33.3%), leflunomide (16.7%), cyclosporin (12.5%), azathioprine (8.3%), and TNF-a inhibitors (4.2%). The most commonly isolated NTM organism was mycobacterium avium complex (83.4%), followed by mycobacterium abscessus (12.5%) and mycobacterium fortuitum (4.2%). Seventeen patients (70.8%) required treatment for pulmonary NTM disease. Of these, 12 patients (70.6%) achieved culture negative conversion. The culture negative conversion rate in patients with rheumatic diseases was comparable to those without underlying rheumatic diseases from our institution. Furthermore, various immunosuppressive agents did not influence the rate of culture negative conversion. Dissemination or progression of pulmonary NTM disease was not observed.
Our study demonstrates that pulmonary NTM disease in patients with underlying rheumatic diseases may not have worse clinical consequences compared to those without. With proper treatment, the outcome of pulmonary NTM disease as assessed by culture negative conversion rate is comparable to those without rheumatic diseases despite the use of various immunosuppressive drugs.
To cite this abstract, please use the following information:
Noh, Jung Won, Hwang, Jiwon, Lee, Jaejoon, Ahn, Joong Kyong, Jeon, Chan Hong, Kim, Jinseok, et al; Outcome of Pulmonary NTM Disease in Patients with Underlying Rheumatic Disease:A Retrospective Observational Study. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1192