Management of infections in rheumatic patients receiving biological therapies. The Portuguese Society of Rheumatology recommendations.
BACKGROUND
Infections are a major cause of morbidity and mortality in systemic inflammatory rheumatic diseases and the management of infectious complications in patients under biological therapies deserves particular attention.


OBJECTIVE
Develop evidence-based recommendations for the management of infections in rheumatic patients receiving biological therapies.


METHODS
A search in PubMed (until 10 November 2014) and EMBASE (until 20 December 2014) databases was performed. Patients with systemic inflammatory rheumatic diseases treated with approved biologics in whom infections occurred were included. Search results were submitted to title and abstract selection, followed by detailed review of suitable studies. Information regarding presentation of the infectious complication, its diagnosis, treatment, and outcome, as well as maintenance or discontinuation of the biological agent was extracted and subsequently pooled according to the type of infection considered. Results of literature review were presented and critically reviewed in a dedicated meeting by a multidisciplinary panel. Recommendations were then formulated using the Delphi method. Finally, the level of agreement among rheumatologists was voted using an online survey.


RESULTS
Fifteen recommendations were issued. Nine general recommendations concerned the assessment of infectious risk before and while on biologics, the procedures in case of suspected infection and the management of biologics during infectious complications. Six specific recommendations were developed for respiratory, urinary, gastrointestinal, skin, osteoarticular and disseminated infections.


CONCLUSIONS
These fifteen recommendations are intended to help rheumatologists in the management of infections in patients on biological therapy. They integrate an extensive literature review, expert opinion and inputs from Portuguese rheumatologists.
Hospital Garcia de Orta.
Lídia
L
Teixeira
Centro Hospitalar São João, Porto.
Ana Rita
AR
Fonseca
Centro Hospitalar e Universitário de Coimbra.
Gisela
G
Eugénio
Centro Hospitalar e Universitário de Coimbra.
Marília
M
Rodrigues
Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa.
Nikita
N
Khmelinskii
Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa.
Sílvia
S
Fernandes
Centro Hospitalar Lisboa Ocidental.
Sofia
S
Serra
Centro Hospitalar Lisboa Ocidental.
Tiago
T
Costa
Hospital Garcia de Orta; Instituto de Medicina Molecular - Faculdade de Medicina de Lisboa.
Maria José
MJ
Santos
D001688:Biological Products / Q000627:therapeutic use*; D001691:Biological Therapy; D006801:Humans; D007239:Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy
D001688:Biological Products