Abstract
Patients with systemic lupus erythematosus (SLE) have a higher incidence of tuberculosis (TB)infection compared to the general healthy population. The use of glucocorticoids and immunosuppressive agents for SLE management further elevates TB risk. This study aimed to evaluate the prevalence of latent tuberculosis infection (LTBI) in SLE patients and explore risk factors for progression to active TB (ATB) in those with concurrent SLE and LTBI. We conducted a retrospective analysis of SLE patients treated at the Department of Rheumatology and Immunology, Peking University Shenzhen Hospital, between 2014 and 2023. During a five - year follow - up period, LTBI was detected in 122 patients (24.11%). Of these, 11 individuals (all from the subgroup of 108 patients who did not receive tuberculosis preventive treatment [TPT]) progressed to ATB. A comparative analysis between the 11 ATB cases and 111 non-progressing LTBI patients revealed significant differences: ATB cases showed higher cyclophosphamide (CTX) usage, elevated high-sensitivity C-reactive protein (hs-CRP) levels, and less frequent hydroxychloroquine (HCQ)administration. These findings underscore the need for regular monitoring during prolonged CTX therapy, especially in moderate-to-high TB burden regions, and highlight the potential protective role of HCQ.