Prévention des infections et vaccination dans les rhumatismes inflammatoires chroniques

Patients with chronic inflammatory rheumatisms (CIR) have a higher risk of infections compared to healthy subjects. Viral and bacterial pneumonia are the most frequent infections observed in CIR under targeted DMARDs. Moreover, drugs used to treat CIR and especially biologic and synthetic targeted disease modifying anti-rheumatic drugs (DMARDs) increase this risk of infection and expose CIR patients to opportunistic infections such as tuberculosis reactivation. In order, to limit the risk of infection, the benefit and risk ratio has to be evaluated for each patient according to characteristics and comorbidities. To prevent infections, an initial pretreatment work up has to be performed especially before initiation of conventional synthetic DMARDs or biological and synthetic targeted DMARDs. This pre-therapeutic assessment is based on questioning, biological and morphological explorations as well. Vaccination's update has to be checked and recommended vaccines for patients with auto-immune diseases and treated with conventional synthetic DMARDs, bDMARDs, tsDMARDs and/or steroids should be done. Information and education of patients are very important. During specific workshop, they learn how to manage drugs in situations at risk and they learn symptoms that require drug discontinuation.