Practice guidelines for diagnosis, treatment, and prevention of tuberculosis in patients with rheumatic disease (2025 edition)

China is a high-burden country for tuberculosis (TB), and patients with rheumatic diseases (RD) are at significantly increased risk of TB infection and progression. Currently, there are no comprehensive clinical practice guidelines providing recommendations for the screening, diagnosis, treatment, and prevention of TB in RD patients. To address this issue, the Collaborative Group for TB Prevention and Control in Patients with RD in China, in collaboration with the Chinese Society of Clinical Epidemiology and Evidence-Based Medicine, Chinese Society of Rheumatology, Chinese Society of Tuberculosis and Chinese Society of Infectious Diseases, developed evidence-based recommendations. These were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) standards. Based on the 14 clinical questions formed from the preliminary research, including: (1) which RD patients need to be screened for TB; (2) how to select the screening methods for TB; (3) whether to conduct re-screening for latent tuberculosis infection (LTBI) after the initial screening is negative; (4) how to diagnose and differentiate RD patients with active tuberculosis (ATB); (5) the indications and courses of empirical anti-TB treatment for RD patients suspected of ATB; (6) how to diagnose drug-resistant TB in RD patients with ATB; (7) the characteristics and management of subclinical TB in RD patients with ATB; (8) the recommended treatment regimens and courses for TB in RD patients; (9) the interaction between anti-TB drugs and RD treatment drugs and how to choose alternative regimens; (10) how to handle adverse drug reactions during anti-TB treatment in RD patients; (11) how to evaluate the effectiveness of anti-TB treatment in RD patients; (12) the indications for initiating tuberculosis preventive treatment (TPT) in RD patients; (13) the recommended regimens and courses for TPT in RD patients; (14) the protection period of TPT and whether to repeat it, detailed evidence-based recommendations were provided, aiming to offer decision support for clinical practice.

我国是结核病高负担国家。风湿免疫病（RD）患者是结核感染和发病的高风险人群。目前尚无综合性临床实践指南对RD患者结核病的筛查、诊断、治疗和预防给出建议。因此，中国风湿免疫病人群结核病防控协作组、中华医学会临床流行病学和循证医学分会、中华医学会风湿病学分会、中华医学会结核病学分会、中华医学会感染病学分会，基于当前可获得的最佳证据，采用推荐意见分级的评估、制订及评价（GRADE）分级体系和卫生保健实践指南报告规范（RIGHT），就前期调研形成的14个临床问题，包括：（1）哪些RD人群需要进行结核病筛查；（2）如何选择结核病的筛查方法；（3）潜伏结核感染初次筛查阴性后是否需要再次进行筛查；（4）RD合并活动性结核病（ATB）如何进行诊断及鉴别诊断；（5）疑诊ATB的RD患者中诊断性抗结核治疗的指征和疗程；（6）RD合并ATB患者中如何诊断耐药结核病；（7）RD合并ATB患者中亚临床结核病的特点及处理；（8）RD患者结核病治疗的推荐方案和疗程；（9）抗结核药物与RD治疗药物的相互作用情况如何及如何选择替代方案；（10）如何处理RD患者抗结核治疗过程中的药物不良反应；（11）如何评估RD患者抗结核治疗的疗效；（12）RD患者启动结核病预防性治疗的指征是什么；（13）RD患者结核病预防性治疗的推荐方案和疗程如何；（14）结核病预防性治疗的保护时限及是否要重复预防，给出了较为详细的循证推荐，旨在为临床实践提供决策支持。.