TY - JOUR
AU - Fragoulis, George E.
AU - Dey, Mrinalini
AU - Zhao, Sizheng
AU - Schoones, Jan W.
AU - Courvoisier, Delphine
AU - Galloway, James
AU - Hyrich, Kimme L.
AU - Nikiphorou, Elena
PY - 2022
DA - November
TI - Systematic literature review informing the 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases
JO - RMD Open
VL - 8
IS - 2
DO - http://dx.doi.org/10.1136/rmdopen-2022-002726
AB - 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 and (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 and Cochrane Library. Exclusion criteria: studies on postoperative infections, paediatric AIIRD, COVID-19, vaccinations and non-Εnglish literature. Study quality was assessed with Newcastle-Ottawa scale for non-randomised 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 disease modifying anti-rheumatic drugs (DMARDs) and its performance is inferior to interferon gamma release assay (IGRA). Agreement between TST and IGRA is moderate to low. For hepatitis B virus (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/or HBV-viral load. Risk for Hepatitis C reactivation is existing but low in patients treated with biological DMARDs. For Pneumocystis jirovecii, prophylaxis treatment should be considered in patients treated with prednisolone ≥15–30 mg/day for &gt;2–4 weeks. Conclusions: Different screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics.
PB - BMJ Publishing Group
UR - https://eprints.gla.ac.uk/285812/
KW - Coronavirus (COVID-19)
ER