EC Pulmonology and Respiratory Medicine

Introduction: The estimated global incidence and mortality of tuberculosis (TB) decreased between 2000-2021.

The risk of TB in rheumatoid arthritis (RA) is higher than in the general population, due to the impaired immune reactivity of elderly patients with autoimmune disease, steroid therapy, and the introduction of new disease modifying drugs.

Recognition of inactive tuberculosis and subclinical exacerbation of tuberculotic processes in RA or in other autoimmune diseases is a great challenge for physicians.

Aim of the Study: The aim of this study was to demonstrate the close connection between TB and granulomatous type of autoimmune vasculitis (gr AV) in RA, and demonstrate the value of the histological diagnosis of latent TB.

Patients and Methods: One hundred sixty-one (161) random autopsy patients with RA were studied.

Characteristics of TB and AV were analyzed histologically, and the relationship between TB and AV were evaluated statistically.

Results and Conclusion: RA can be associated with or complicated by autoimmune vasculitis at any age, in both sexes, and at any time in the course of the disease.

The risk of TB (without significance) and AV (at a significant level) is higher in elderly RA patients than in younger ones, especially elderly women are more likely to be affected by TB (without significance) or AV (at significant level).

Recognition of dormant TB without radiological evidence and diagnosis of AV without visible skin involvement is an implicit demand for proof.

Definitive diagnosis of vasculitis should be made upon biopsy of involved tissue.

Granulomatous autoimmune vasculitis can be regarded as an indirect histological sign of dormant TB with or without miliary dissemination, supported by the close relationship between epithelioid granulomas and granulomatous involvement of blood vessels, independently of the biopsy sites.

Histological diagnosis of granulomatous vasculitis should alert clinicians to identify possible co-existent TB.

Keywords: Tuberculosis; Autoimmune Vasculitis; Epithelioid Granuloma; Granulomatous Vasculitis

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