Objective: To study the clinical value of T-cell enzyme-linked immunospot assay (T-SPOT.TB) in the diagnosis of rheumatic immune diseases complicated with Mycobacterium tuberculosis. Methods: Patients admitted to the Department of Rheumatology and Immunology of Sanya People’s Hospital from January 2016 to December 2018 were included. 48 patients with rheumatic immune disease complicated with Mycobacterium tuberculosis were selected as the study group, 59 patients with solely rheumatic immune disease were selected as the rheumatic control group, and 63 healthy volunteers were enrolled as the normal control group. The examination of T-SPOT.TB and TB-Ab in the three groups were compared, and the two diagnostic methods were evaluated methodologically. Results: The positive rates of T-SPOT.TB and TB-Ab in the study group were respectively 83.33% and 50.00%, higher than those in the rheumatic control group (respectively 6.78% and 7.93%) and those in the normal control group (respectively 15.25% and 3.17%), and the differences were statistically significant (P<0.05). The sensitivity (83.33%), specificity (95.08%), negative predictive value (93.55%) and positive predictive value (86.96%) of T-SPOT.TB in the diagnosis of rheumatic immune disease complicated with tuberculosis were both better than those of TB-Ab. Conclusion: T-SPOT.TB has high clinical value in the diagnosis of rheumatic immune disease with tuberculosis infection.