Background: Biological agents have revolutionized the management of chronic inflammatory rheumatisms (CIR), significantly improving patients’ quality of life. However, this advancement is not without risks, and the emergence of tuberculosis as an adverse effect is a growing concern, particularly in endemic regions.

Objectives: Our study aims to assess the frequency of tuberculosis in the context of chronic inflammatory rheumatisms, along with the clinical and paraclinical profile of affected patients.

Methods: Cohort Study with Retrospective Data Collection on Patients with CIR over a 5-Year Period from January 2018 to January 2023. The cohort includes patients monitored for rheumatoid arthritis and spondylarthritis based on ACR 2010 and ASAS criteria, respectively, who have been administered biological agents. All patients underwent epidemiological, clinical, and paraclinical assessments (QuantiFERON test and chest X-ray) before starting biologic therapy. Patients with a positive QuantiFERON test received chemoprophylaxis according to the national protocol. Patient data were collected and analyzed.

Results: We included 134 patients monitored for Chronic Inflammatory Rheumatisms (81 RA/52 SA). The female-to-male ratio was 1.3. The mean age was 44 years (±15.5). The average disease duration was 15 years (±7.96). No recent tuberculosis exposure (<6 months) was observed. Six cases of tuberculosis were identified under biologic therapy, with a frequency of 4%. We noted 2 cases of miliary pulmonary tuberculosis, 2 cases of gastrointestinal tuberculosis, one case of neuro-meningeal tuberculosis, and one case of lymph node tuberculosis. The average diagnostic delay for tuberculosis is 28 weeks. All tuberculosis cases occurred under Anti-TNF therapy: 5 cases with Infliximab and one case with Adalimumab. The clinical presentation of tuberculosis in our series was marked by general malaise in all patients, cough in 2 cases, digestive symptoms in 2 cases, and cauda equina syndrome in one case. The diagnosis was confirmed by bacteriological testing in 3 cases, histopathological examination in 2 cases, and clinical-radiological findings in one patient. All patients received anti-tubercular drugs according to the national protocol, with favorable outcomes in 4 cases and fatal outcomes in 2 patients.

Conclusion: The frequency of tuberculosis under biologic therapy, although relatively low at 4% in our study, nevertheless underscores the need for close monitoring and thorough pre-treatment assessment before initiating this type of therapy. The results demonstrate that, despite precautions taken, cases of tuberculosis can occur, highlighting the complexity of managing this population of immunocompromised patients.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.