系统文献回顾为 2022 年 EULAR 成人自身免疫性炎症性风湿病患者慢性和机会性感染筛查和预防建议提供信息。
Systematic literature review informing the 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases.
机构信息
Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
出版信息
RMD Open. 2022 Nov;8(2). doi: 10.1136/rmdopen-2022-002726.
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 , prophylaxis treatment should be considered in patients treated with prednisolone ≥15-30 mg/day for >2-4 weeks.
CONCLUSIONS
Different screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics.
目的
对自身免疫性炎症性风湿病（AIIRD）中的机会性和慢性感染的筛查和预防进行系统文献回顾（SLR）。
方法
基于以下搜索领域进行 SLR（启动-12/2021）：（1）感染因子，（2）AIIRD，（3）风湿病中使用的免疫抑制剂/免疫调节剂，（4）筛查术语和（5）预防措施。从（1）和（2）和（3）加上（4）或（5）中检索包含这些术语的文章。检索的数据库：PubMed、Embase 和 Cochrane Library。
排除标准
术后感染、儿科 AIIRD、COVID-19、疫苗接种和非英语文献的研究。使用纽卡斯尔-渥太华量表对非随机对照试验（RCT）、RCT 的 RoB-Cochrane、SLR 的 AMSTAR2 评估研究质量。
结果
从 5641 项研究中检索到 568 篇全文文章进行资格评估，最终纳入 194 篇文章。对于结核病，结核菌素皮肤试验（TST）受到糖皮质激素和常规合成的疾病修饰抗风湿药物（DMARDs）治疗的影响，其性能不如干扰素释放试验（IGRA）。TST 和 IGRA 之间的一致性为中度至低度。对于乙型肝炎病毒（HBV）：乙型肝炎表面抗原阳性患者的病毒再激活风险增加。抗-HBcore 阳性患者再激活风险低，但应定期进行肝功能检查和/或 HBV 病毒载量监测。接受生物 DMARD 治疗的患者，丙型肝炎病毒再激活的风险存在但较低。对于，在接受泼尼松龙≥15-30mg/天治疗>2-4 周的患者中，应考虑预防治疗。
结论
文献中描述了不同的筛查和预防方法，部分取决于个体患者和疾病特征。
Zotero 插件