New EULAR recommendations for screening and treatment of infections in AIIRD patients

New EULAR recommendations for screening and treatment of infections in AIIRD patients

It is already known that people with weakened immune systems are more susceptible to infections. Chronic and opportunistic infections are common in people with AIIRD and may be associated with some of the immunosuppressive and immunomodulatory treatments used to treat these rheumatic diseases. An example of an opportunistic infection that may occur more frequently in people with AIIRD is tuberculosis (TB). This infection may not have any symptoms but can be reactivated and spread to other people. There is also a risk of hepatitis reactivation. These infections and reactivations can be prevented by antiviral treatment or vaccination if taken before starting treatment with disease-modifying anti-rheumatic drugs (DMARDs), which can suppress the immune system. It is recommended that healthcare professionals screen their AIIRD patients for these types of infections before prescribing DMARDs, but in practice, people's methods vary and appropriate recommendations are traditionally lacking.

These new EULAR recommendations were developed by an international task force. This included patient research partners as well as healthcare professionals with expertise in rheumatology, infections and respiratory diseases. The information is based on findings from a systematic literature search that examined studies on the screening and prophylaxis of chronic and opportunistic infections. Based on the available evidence, the group drafted a range of possible statements and voted on their inclusion in the final recommendations.

The paper, developed by EULAR and published in the November 2022 issue of Annals of the Rheumatic Diseases, contains four overarching principles and eight recommendations. The overarching principles emphasize that the risk of chronic and opportunistic infections should be considered and discussed with all AIIRD patients before initiating treatment with DMARDs, immunosuppressants, or glucocorticoids. These risks should also be reassessed from time to time. When deciding on screening and prophylaxis of chronic and opportunistic infections, the patient's individual risk factors should be taken into account. Achieving this requires collaboration between rheumatologists and other specialists such as infectious disease doctors, gastroenterologists, hepatologists and pulmonologists. Finally, in addition to the new EULAR recommendations, national guidelines and recommendations should also be taken into account, as well as possible regional factors that could play a role, such as: B. Diseases that are more common in some areas than others.

In this new publication, EULAR now provides guidelines and specific recommendations for screening for TB, hepatitis and HIV in people with AIIRD before starting DMARD treatment. The recommendations also suggest that healthcare professionals provide information and training to people without varicella zoster immunity so that they understand their risks of developing herpes zoster in the future. There is also a recommendation to provide preventive treatment to some patients taking high doses of glucocorticoids to prevent them from getting Pneumocystis pneumonia infection.

The recommendations provide important guidance for screening and prevention of chronic and opportunistic infections in people with AIIRD. EULAR hopes that their introduction into daily clinical practice will help standardize and optimize care and ultimately reduce the burden of opportunistic infections in people with AIIRD.

Source:

European Alliance of Rheumatology Associations, EULAR

Reference:

Fragoulis, GE, et al. (2022) 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases. Annals of rheumatic diseases. doi.org/10.1136/ard-2022-223335.

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