https://doi.org/10.4081/reumatismo.2026.1905
An overview of the relation between tuberculosis and autoantibodies: a systematic review
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 9 September 2026
Objective. Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a significant global health concern. While traditionally viewed as an infectious disease primarily affecting the lungs, accumulating evidence suggests a complex interplay between TB and the host's immune system, potentially leading to the production of autoantibodies. This systematic review aims to investigate the frequency of autoantibody positivity among active TB patients.
Methods. A comprehensive search of major electronic databases such as PubMed, Scopus, Google Scholar, and Web of Science was performed. The search strategy employed keywords including "tuberculosis", "autoantibodies", and specific autoantibody names such as "ANA", "Anti-dsDNA", “Anti-phospholipid”, “ANCA”, "RF" and "ACPA" to study the link between TB and autoantibodies. How often autoantibodies are found in TB patients and what this means for diagnosis and treatment, was analyzed.
Results. The results indicate a diverse spectrum of autoantibodies among patients with TB. Some of the autoantibodies, such as rheumatoid factor and anti-phospholipid antibodies, are frequently detected. This can pose diagnostic challenges by mimicking autoimmune diseases and may have implications for monitoring treatment response. Furthermore, the bidirectional relationship between TB and autoimmune diseases, where one can increase the risk of the other, underscores the need for careful clinical consideration.
Conclusions. Understanding this complex association is crucial for improving the management of TB, especially in individuals with or at risk of autoimmune conditions.
Downloads
Bagcchi S. WHO's global tuberculosis report 2022. Lancet Microbe 2023; 4: e20. DOI: https://doi.org/10.1016/S2666-5247(22)00359-7
Pisetsky DS. Pathogenesis of autoimmune disease. Nat Rev Nephrol 2023; 19: 509-24. DOI: https://doi.org/10.1038/s41581-023-00720-1
Nielsen PR, Kragstrup TW, Deleuran BW, Benros ME. Infections as risk factor for autoimmune diseases–a nationwide study. Journal of autoimmunity 2016; 74: 176-81. DOI: https://doi.org/10.1016/j.jaut.2016.05.013
Belyaeva IV, Kosova AN, Vasiliev AG. Tuberculosis and autoimmunity. Pathophysiology 2022; 29: 298-318. DOI: https://doi.org/10.3390/pathophysiology29020022
Yablonskiy PK, Belyaeva IV, Churilov LP, Erman MV, Kudryavtsev IV, Malkova АM, et al. Tuberculosis and autoimmunity: well-coordinated duo. In: Infection and autoimmunity. Cambridge, MA, USA: Academic Press; 2024. pp. 517-41. DOI: https://doi.org/10.1016/B978-0-323-99130-8.00018-0
Galipeau Y, Cooper C, Langlois MA. Autoantibodies in COVID-19: implications for disease severity and clinical outcomes. Front Immunol 2025; 15: 1509289. DOI: https://doi.org/10.3389/fimmu.2024.1509289
Dobrowolska K, Zarębska‐Michaluk D, Poniedziałek B, Jaroszewicz J, Flisiak R, Rzymski P. Overview of autoantibodies in COVID‐19 convalescents. J Med Virol 2023; 95: e28864. DOI: https://doi.org/10.1002/jmv.28864
Tugwell P, Tovey D. PRISMA 2020. J Clin Epidemiol 2021; 134: A5-6. DOI: https://doi.org/10.1016/j.jclinepi.2021.04.008
Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M, Tugwell P. Newcastle-Ottawa quality assessment scale cohort studies. University of Ottawa 2014: B-10.
Cheng MP, Butler-Laporte G, Parkes LO, Bold TD, Fritzler MJ, Behr MA. Prevalence of auto-antibodies in pulmonary tuberculosis. Open Forum Infect Dis 2019; 6: ofz114. DOI: https://doi.org/10.1093/ofid/ofz114
Elkayam O, Caspi D, Lidgi M, Segal R. Auto-antibody profiles in patients with active pulmonary tuberculosis. Int J Tuberc Lung Dis 2007; 11: 306-10.
Faris MH, Athab AM, Fadhil RM. Evaluation of auto-antibody profiles in patients with tuberculosis. DJM 2018; 15: 50-60. DOI: https://doi.org/10.26505/DJM.15014050429
Emami S. Serum level of anti-CCP in patients with active pulmonary tuberculosis. Biomed J Sci Tech Res 2017; 1: 947-50. DOI: https://doi.org/10.26717/BJSTR.2017.01.000338
Naher N, Imam H, Biswas SK, Biswas T, Azad M, Hasan MN, et al. Frequency of positive antinuclear antibody in people with active tuberculosis and its changes with antitubercular therapy. Cureus 2025; 17: e81116. DOI: https://doi.org/10.7759/cureus.81116
Chander Y, Acharya N, Naidu GS, Rathi M, Minz R, Jain S, et al. Prevalence of antineutrophil cytoplasmic antibodies and antinuclear antibodies in patients with pulmonary tuberculosis: a tertiary care center experience from north India. J Assoc Physicians India 2022; 70: 11-2. DOI: https://doi.org/10.5005/japi-11001-0126
Pradhan VD, Badakere SS, Ghosh K, Pawar AR. Spectrum of anti-neutrophil cytoplasmic antibodies in patients with pulmonary tuberculosis overlaps with that of Wegener’s granulomatosis. Indian J Med Sci 2004; 58: 283-8.
Adebajo AO, Charles P, Maini RN, Hazleman BL. Autoantibodies in malaria, tuberculosis and hepatitis B in a west African population. Clin Exp Immunol 1993; 92: 73-6. DOI: https://doi.org/10.1111/j.1365-2249.1993.tb05950.x
Isenberg DA, Maddison P, Swana G, Skinner RP, Swana M, Jones M, et al. Profile of autoantibodies in the serum of patients with tuberculosis, klebsiella and other gram-negative infections. Clin Exp Immunol 1987; 67: 516-23.
Shen CY, Hsieh SC, Yu CL, Wang JY, Lee LN, Yu CJ. Autoantibody prevalence in active tuberculosis: reactive or pathognomonic? BMJ Open 2013; 3: e002665. DOI: https://doi.org/10.1136/bmjopen-2013-002665
Shahzad F, Ali A, Mushtaq A, Javaid K, Nazir A, Pervez A, et al. Raised dsDNA autoantibodies in tuberculosis patients. Egypt J Chest Dis Tuberc 2019; 68: 28-31. DOI: https://doi.org/10.4103/ejcdt.ejcdt_98_18
Ms G, Narasimhan PB, Kavadichanda C, Gopal A, Bairwa D, Thabah MM, et al. AB0558 prevalence of latent tuberculosis infection and its associations with clinical and serological parameters in systemic lupus erythematosus. Ann Rheum Dis 2022; 81: 1406. DOI: https://doi.org/10.1136/annrheumdis-2022-eular.4680
Elkayam O, Segal R, Lidgi M, Caspi D. Positive anti-cyclic citrullinated proteins and rheumatoid factor during active lung tuberculosis. Ann Rheum Dis 2006; 65: 1110-2. DOI: https://doi.org/10.1136/ard.2005.045229
Starshinova A, Malkova A, Zinchenko Y, Kudryavtsev I, Serebriakova M, Akisheva T, et al. Identification of autoimmune markers in pulmonary tuberculosis. Front Immunol 2023; 13: 1059714. DOI: https://doi.org/10.3389/fimmu.2022.1059714
Lima I, Oliveira RC, Atta A, Marchi S, Barbosa L, Reis E, et al. Antibodies to citrullinated peptides in tuberculosis. Clin Rheumatol 2013;32:685-7. DOI: https://doi.org/10.1007/s10067-013-2173-y
Rapoport BL, Morrison RC, Sher R, Dos Santos L. A study of autoantibodies in chronic mycobacterial infections. Int J Lepr Other Mycobact Dis 1990; 58: 518-25.
Elkayam O, Segal R, Bendayan D, van Uitert R, Onnekink C, Pruijn GJ. The anti-cyclic citrullinated peptide response in tuberculosis patients is not citrulline-dependent and sensitive to treatment. Arthritis Res Ther 2010; 12: R12. DOI: https://doi.org/10.1186/ar2913
Kakumanu P, Yamagata H, Sobel ES, Reeves WH, Chan EK, Satoh M. Patients with pulmonary tuberculosis are frequently positive for anti–cyclic citrullinated peptide antibodies, but their sera also react with unmodified arginine‐containing peptide. Arthritis Rheum 2008; 58: 1576-81. DOI: https://doi.org/10.1002/art.23514
Elkayam O, Bendayan D, Segal R, Shapira Y, Gilburd B, Reuter S, et al. The effect of anti-tuberculosis treatment on levels of anti-phospholipid and anti-neutrophil cytoplasmatic antibodies in patients with active tuberculosis. Rheumatol Int 2013; 33: 949-53. DOI: https://doi.org/10.1007/s00296-012-2487-0
Goodridge A, Cueva C, Lahiff M, Muzanye G, Johnson JL, Nahid P, Riley LW. Anti-phospholipid antibody levels as biomarker for monitoring tuberculosis treatment response. Tuberculosis 2012; 92: 243-7. DOI: https://doi.org/10.1016/j.tube.2012.02.004
Takenami I, De Oliveira CC, Petrilli JD, Machado A, Riley LW, Arruda S. Serum antiphospholipid antibody levels as biomarkers for diagnosis of pulmonary tuberculosis patients. Int J Tuberc Lung Dis 2018; 22: 1063-70. DOI: https://doi.org/10.5588/ijtld.17.0874
Bessis S, Bertin D, Million M, Meddeb L, Drancourt M, Lagier JC, et al. Thromboses in tuberculosis are linked to antiphosphatidylethanolamine antibodies levels: a cross-sectional study. J Clin Tuberc Other Mycobact Dis 2019; 15: 100092. DOI: https://doi.org/10.1016/j.jctube.2019.100092
Sherkat R, Mostafavizadeh K, Zeydabadi L, Shoaei P, Rostami S. Antineutrophil cytoplasmic antibodies in patients with pulmonary tuberculosis. Iran J Immunol 2011; 8: 52-7.
Hussein S, Ismael M, Abdulmajeed N. Antineutrophil cytoplasmic antibodies in patients with tuberculosis. Iraqi J Sci 2014; 55: 360-6.
Teixeira L, Mahr A, Jaureguy F, Noel LH, Nunes H, Lefort A, et al. Low seroprevalence and poor specificity of antineutrophil cytoplasmic antibodies in tuberculosis. Rheumatology 2005; 44: 247-50. DOI: https://doi.org/10.1093/rheumatology/keh467
Esquivel-Valerio JA, Flores-Suárez LF, Rodríguez-Amado J, Garza-Elizondo MA, Rendón A, Salinas-Carmona MC. Antineutrophil cytoplasm autoantibodies in patients with tuberculosis are directed against bactericidal/permeability increasing protein and are detected after treatment initiation. Clin Exp Rheumatol 2010; 28: 35-9.
Flores‐Suárez LF, Cabiedes J, Villa AR, Van der Woude FJ, Alcocer‐Varela J. Prevalence of antineutrophil cytoplasmic autoantibodies in patients with tuberculosis. Rheumatology 2003; 42: 223-9. DOI: https://doi.org/10.1093/rheumatology/keg066
Lima I, Oliveira RC, Cabral MS, Atta A, Marchi S, Reis E, et al. Anti-PR3 and anti-MPO antibodies are not present in sera of patients with pulmonary tuberculosis. Rheumatol Int 2014; 34: 1231-4. DOI: https://doi.org/10.1007/s00296-014-3009-z
Huan G, Yang G, Xiao-Yu Q, Jiancheng X, Yan-Qing S. Antineutrophil cytoplasmic antibodies in Chinese patients with tuberculosis. Rev Soc Bras Med Trop 2018; 51: 475-8. DOI: https://doi.org/10.1590/0037-8682-0400-2017
Xie X, Li F, Chen JW, Wang J. Risk of tuberculosis infection in anti-TNF-α biological therapy: from bench to bedside. J Microbiol Immunol Infect 2014; 47: 268-74. DOI: https://doi.org/10.1016/j.jmii.2013.03.005
Lorenzetti R, Zullo A, Ridola L, Diamanti AP, Lagana B, Gatta L, et al. Higher risk of tuberculosis reactivation when anti-TNF is combined with immunosuppressive agents: a systematic review of randomized controlled trials. Ann Med 2014; 46: 547-54 DOI: https://doi.org/10.3109/07853890.2014.941919
Picchianti-Diamanti A, Aiello A, De Lorenzo C, Migliori GB, Goletti D. Management of tuberculosis risk, screening and preventive therapy in patients with chronic autoimmune arthritis undergoing biotechnological and targeted immunosuppressive agents. Front Immunol 2025; 16: 1494283. DOI: https://doi.org/10.3389/fimmu.2025.1494283
Lalvani A, Millington KA. Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmun Rev 2008; 8: 147-52. DOI: https://doi.org/10.1016/j.autrev.2008.07.011
Wu Q, Liu Y, Wang W, Zhang Y, Liu K, Chen SH, Chen B. Incidence and prevalence of tuberculosis in systemic lupus erythematosus patients: a systematic review and meta-analysis. Front Immunol 2022; 13: 938406. DOI: https://doi.org/10.3389/fimmu.2022.938406
Chang YS, Liu CJ, Ou SM, Hu YW, Chen TJ, Lee HT, et al. Tuberculosis infection in primary Sjögren’s syndrome: a nationwide population-based study. Clin Rheumatol 2014; 33: 377-83. DOI: https://doi.org/10.1007/s10067-013-2408-y
Starshinova A, Malkova А, Kudryavtsev I, Kudlay D, Zinchenko Y, Yablonskiy P. Tuberculosis and autoimmunity: common features. Tuberculosis 2022; 134: 102202. DOI: https://doi.org/10.1016/j.tube.2022.102202
Asherson RA, Gunter K, Daya D, Shoenfeld Y. Multiple autoimmune diseases in a young woman: tuberculosis and splenectomy as possible triggering factors? Another example of the “mosaic” of autoimmunity. J Rheumatol 2008; 35: 1224-6.
Rueda JC, Crepy MF, Mantilla RD. Clinical features of Poncet’s disease. From the description of 198 cases found in the literature. Clin Rheumatol 2013; 32: 929-35. DOI: https://doi.org/10.1007/s10067-013-2270-y
Liu Y, Che G, Liu Y, Xu K. Tuberculosis mimicking the onset of systemic lupus erythematosus flare: case based review. Int J Rheum Dis 2023; 26: 1143-8. DOI: https://doi.org/10.1111/1756-185X.14585
Lin YC, Liang SJ, Liu YH, Hsu WH, Shih CM, Sung FC, Chen W. Tuberculosis as a risk factor for systemic lupus erythematosus: results of a nationwide study in Taiwan. Rheumatol Int 2012; 32: 1669-73. DOI: https://doi.org/10.1007/s00296-011-1847-5
Shapira Y, Agmon-Levin N, Shoenfeld Y. Mycobacterium tuberculosis, autoimmunity, and vitamin D. Clin Rev Allergy Immunol 2010; 38: 169-77. DOI: https://doi.org/10.1007/s12016-009-8150-1
CRediT authorship contribution
Shirin Assar: study concept and design. Dena Mohamadzadeh, Faraneh Farsad: data collection. Dena Mohamadzadeh, Shirin Assar, Faraneh Farsad: data analysis, draft of the manuscript, approval of the final manuscript.
How to Cite

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.