2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases
Year: 2022
Type: review
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 biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) for which screening for latent tuberculosis (TB) should be performed, screening could be considered also before conventional synthetic DMARDs, glucocorticoids and immunosuppressants. Interferon gamma release assay should be preferred over tuberculin skin test, where available. Hepatitis B (HBV) antiviral treatment should be guided by HBV status defined prior to starting antirheumatic 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 postexposure prophylaxis should they have contact with this pathogen. Prophylaxis against Pneumocystis jirovecii seems to be beneficial in patients treated with daily doses >15–30 mg 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 standardise and optimise care to reduce the burden of opportunistic infections in people living with AIIRD.
Source: Annals of the Rheumatic Diseases
Authors: George E Fragoulis, Elena Nikiphorou, Mrinalini Dey, Sizheng Steven Zhao, Delphine Sophie Courvoisier, Laurent Arnaud, Fabiola Atzeni, Georg MN Behrens, Johannes WJ Bijlsma, Peter Böhm, Costas A Constantinou, Silvia Garcia-Diaz, Meliha Crnkic Kapetanovic, Kim Lauper, Mariana Luís, Jacques Morel, György Nagy, Eva Polverino, Jef van Rompay, Marco Sebastiani, Anja Strangfeld, Annette de Thurah, James Galloway, Kimme L Hyrich
Institutions: National and Kapodistrian University of Athens, University of Glasgow, King's College London, University of Liverpool, Countess of Chester Hospital NHS Foundation Trust, Countess of Chester Hospital, University of Manchester, Centre for Epidemiology Versus Arthritis, University Hospital of Geneva, Hôpitaux Universitaires de Strasbourg, University of Messina, Medizinische Hochschule Hannover, University Medical Center Utrecht, Deutsche Rheuma-Liga, Nicosia General Hospital, Hospital de Sant Joan Despí Moisès Broggi, Lund University, Skåne University Hospital, University of Geneva, Université de Montpellier, Centre Hospitalier Universitaire de Montpellier, Semmelweis University, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, European League Against Rheumatism, University of Modena and Reggio Emilia, German Rheumatism Research Centre, Charité – Universitätsmedizin Berlin, Aarhus University Hospital, Manchester Academic Health Science Centre
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: G2916915574, G4736680341, G6247975539
OpenAlex ID: W4308101846