2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases
Ann. rheum. dis; 82 (6), 2023
Année de publication: 2023
To develop EULAR recommendations for
screening and prophylaxis of chronic and opportunistic
infections in patients with autoimmune inflammatory
rheumatic diseases (AIIRD).
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.
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 >15–30mg of prednisolone or equivalent for
>2–4 weeks.
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.
Disease Prevention, Opportunistic Infections/etiology, Autoimmune Diseases/complications, Rheumatic Diseases/complications, Triage/standards, Tuberculosis/prevention & control, Hepatitis B/prevention & control, Hepatitis C/prevention & control, Herpesvirus 3, Human, Pneumocystis carinii/immunology, Post-Exposure Prophylaxis, Antiviral Agents/therapeutic use