Abstract
Objectives: To develop EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in patients with autoimmune inflammatory rheumatic diseases (AIIRD).
Methods: An international Task Force (TF) (22 members/15 countries) formulated recommendations, supported by systematic literature review findings. Level of evidence and grade of recommendation were assigned for each recommendation. Level of agreement was provided anonymously by each TF member.
Results: Four overarching principles (OAP) and eight recommendations were developed. The OAPs highlight the need for infections to be discussed with patients and with other medical specialties, in accordance with national regulations. In addition to b/tsDMARDs for which screening for latent tuberculosis (TB) should be performed, screening could be considered also before csDMARDs, glucocorticoids and immunosuppressants. Interferon gamma release assay should be preferred over tuberculin skin test, where available. Hepatitis B (HBV) anti-viral treatment should be guided by HBV status defined prior to starting anti-rheumatic drugs. All patients positive for Hepatitis-C-RNA should be referred for antiviral treatment. Also, patients who are non-immune to varicella zoster virus should be informed about the availability of post-exposure prophylaxis should they have contact with this pathogen. Prophylaxis against Pneumocystis jirovecii seems to be beneficial in patients treated with daily doses > 15-30mg of prednisolone or equivalent for > 2-4 weeks..
Conclusions: These recommendations provide guidance on the screening and prevention of chronic and opportunistic infections. Their adoption in clinical practice is recommended to standardize and optimize care to reduce the burden of opportunistic infections in people living with AIIRD.
Methods: An international Task Force (TF) (22 members/15 countries) formulated recommendations, supported by systematic literature review findings. Level of evidence and grade of recommendation were assigned for each recommendation. Level of agreement was provided anonymously by each TF member.
Results: Four overarching principles (OAP) and eight recommendations were developed. The OAPs highlight the need for infections to be discussed with patients and with other medical specialties, in accordance with national regulations. In addition to b/tsDMARDs for which screening for latent tuberculosis (TB) should be performed, screening could be considered also before csDMARDs, glucocorticoids and immunosuppressants. Interferon gamma release assay should be preferred over tuberculin skin test, where available. Hepatitis B (HBV) anti-viral treatment should be guided by HBV status defined prior to starting anti-rheumatic drugs. All patients positive for Hepatitis-C-RNA should be referred for antiviral treatment. Also, patients who are non-immune to varicella zoster virus should be informed about the availability of post-exposure prophylaxis should they have contact with this pathogen. Prophylaxis against Pneumocystis jirovecii seems to be beneficial in patients treated with daily doses > 15-30mg of prednisolone or equivalent for > 2-4 weeks..
Conclusions: These recommendations provide guidance on the screening and prevention of chronic and opportunistic infections. Their adoption in clinical practice is recommended to standardize and optimize care to reduce the burden of opportunistic infections in people living with AIIRD.
| Original language | English |
|---|---|
| Journal | Annals of the rheumatic diseases |
| DOIs | |
| Publication status | Accepted/In press - 11 Oct 2022 |
