Abstract
Objective: To conduct a systematic literature review (SLR) on the screening and prophylaxis of opportunistic and chronic infections in autoimmune inflammatory rheumatic diseases (AIIRD).
Methods: SLR (inception-12/2021) based on the following search domains: 1) Infectious agents, 2) AIIRD, 3) immunosuppressives/immunomodulators used in rheumatology, 4) screening terms, 5) prophylaxis terms. Articles were retrieved having the terms from 1 AND 2 AND 3, plus terms from 4 OR 5. Databases searched: PubMed, Embase, Cochrane Library. Exclusion criteria: studies on post-operative infections, pediatric AIIRD, Covid-19, vaccinations and non-Εnglish literature. Study quality was assessed with Newcastle-Ottawa scale for non-randomized controlled trials (RCTs), RoB-Cochrane for RCTs, AMSTAR2 for SLRs.
Results: From 5641 studies were retrieved, 568 full-text articles were assessed for eligibility, with 194 articles finally included. For tuberculosis, tuberculin skin test (TST) is affected by treatment with glucocorticoids and conventional synthetic DMARDs (csDMARDs) and its performance is inferior to interferon gamma release assay (IGRA). Agreement between TST and IGRA is moderate to low. For hepatitis B (HBV): risk of reactivation is increased in patients positive for hepatitis B surface antigen. Anti-HBcore positive patients are at low risk for reactivation but should be monitored periodically with liver function tests and HBV-viral load. Risk for Hepatitis C reactivation is existing but low in patients treated with biologic DMARDs. For pneumocystis jirovecii, prophylaxis treatment should be considered in patients treated with prednisolone ≥15-30mg/day for > 2-4 weeks.
Conclusions: Different screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics.
Methods: SLR (inception-12/2021) based on the following search domains: 1) Infectious agents, 2) AIIRD, 3) immunosuppressives/immunomodulators used in rheumatology, 4) screening terms, 5) prophylaxis terms. Articles were retrieved having the terms from 1 AND 2 AND 3, plus terms from 4 OR 5. Databases searched: PubMed, Embase, Cochrane Library. Exclusion criteria: studies on post-operative infections, pediatric AIIRD, Covid-19, vaccinations and non-Εnglish literature. Study quality was assessed with Newcastle-Ottawa scale for non-randomized controlled trials (RCTs), RoB-Cochrane for RCTs, AMSTAR2 for SLRs.
Results: From 5641 studies were retrieved, 568 full-text articles were assessed for eligibility, with 194 articles finally included. For tuberculosis, tuberculin skin test (TST) is affected by treatment with glucocorticoids and conventional synthetic DMARDs (csDMARDs) and its performance is inferior to interferon gamma release assay (IGRA). Agreement between TST and IGRA is moderate to low. For hepatitis B (HBV): risk of reactivation is increased in patients positive for hepatitis B surface antigen. Anti-HBcore positive patients are at low risk for reactivation but should be monitored periodically with liver function tests and HBV-viral load. Risk for Hepatitis C reactivation is existing but low in patients treated with biologic DMARDs. For pneumocystis jirovecii, prophylaxis treatment should be considered in patients treated with prednisolone ≥15-30mg/day for > 2-4 weeks.
Conclusions: Different screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics.
| Original language | English |
|---|---|
| Article number | e002726 |
| Journal | RMD Open |
| Volume | 8 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 2 Nov 2022 |
Keywords
- chronic infections
- opportunistic infections
- screening
- prophylaxis
- autoimmune inflammatory rheumatic diseases
