2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

• Published in: Annals of the rheumatic diseases Vol. 82; no. 6; pp. 742 - 753
• Main Authors: Fragoulis, George E, Nikiphorou, Elena, Dey, Mrinalini, Zhao, Sizheng Steven, Courvoisier, Delphine Sophie, Arnaud, Laurent, Atzeni, Fabiola, Behrens, Georg MN, Bijlsma, Johannes WJ, Böhm, Peter, Constantinou, Costas A, Garcia-Diaz, Silvia, Kapetanovic, Meliha Crnkic, Lauper, Kim, Luís, Mariana, Morel, Jacques, Nagy, György, Polverino, Eva, van Rompay, Jef, Sebastiani, Marco, Strangfeld, Anja, de Thurah, Annette, Galloway, James, Hyrich, Kimme L
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and European League Against Rheumatism 01.06.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adult; Agreements; Antirheumatic Agents; Antirheumatic Agents - therapeutic use; Antiviral agents; Antiviral Agents - therapeutic use; Autoimmune Diseases; Clinical Medicine; Disease prevention; Drug dosages; Drug screening; Epidemiology; Glucocorticoids; Hepatitis B; Human health and pathology; Humans; Immunosuppressive agents; Immunosuppressive Agents - therapeutic use; Infections; Infectious diseases; Infectious Medicine; Infektionsmedicin; Interferon; Klinisk medicin; Life Sciences; Literature reviews; Medical and Health Sciences; Medical personnel; Medicin och hälsovetenskap; Opportunistic Infections - diagnosis; Opportunistic Infections - prevention & control; Pathogens; Patients; Physicians; Prednisolone; Prophylaxis; Recommendation; Rheumatic diseases; Rheumatic Diseases - complications; Rheumatic Diseases - drug therapy; Rheumatology; Rhumatology and musculoskeletal system; Skin tests; Tuberculin; Tuberculosis; Varicella; Antirheumatic Agents; Autoimmune Diseases; Tuberculosis
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard-2022-223335

ObjectivesTo develop EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in patients with autoimmune inflammatory rheumatic diseases (AIIRD).MethodsAn 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.ResultsFour 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.ConclusionsThese 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.