Managing patients with autoimmune inflammatory rheumatic diseases

(Part 2)

This week, we will discuss briefly the development of the recommendations for the treatment of patients with autoimmune inflammatory rheumatic disease (AIIRD).

The current update of the European League Against Rheumatism (EULAR) stipulations of vaccination in patients with AIIRD was an effort to benefit the adult and young AIIRD patients.

After the 2014 updated EULAR standard operating procedure (SOP), the convenor within the EULAR first formed the task force with a steering committee.

The steering committee included the convenor, co-convenor, methodologists, and three fellows who performed the systematic literature reviews (SLRs), one expert rheumatologist and one specialist in infectious diseases.

The steering committee laid out the research questions for the SLRs and organised a one-and-a-half-day meeting of the task force.

Members of the adult AIIRD task force meeting were from seven (7) European countries and Israel. The members included 10 adult rheumatologists, four clinical immunologists, one infectious disease specialist, one pediatricians/rheumatologist, two delegates of the EULAR young rheumatologists’ network, one health professional in rheumatology (HPR) and two patients.

Moreover, three (3) fellows performed four (4) SLRs covering the incidence of the disease, the efficacy, immunogenicity, safety of vaccination in patients with AIIRD, the effect of disease-modifying antirheumatic drugs (DMARDs) on vaccination response and the effect of vaccination in families of AIIRDs patients, including infants, on the prevention of vaccine preventable infections (VPI)and safety of the patients.

Several journals were searched from 1 October 2009 to 1 August 2018. The medical subject headings (MESH) terms included the defined AIIRD, immunosuppressive medications and vaccines.

Only the articles in English were included.

The first part of the meeting was shared by both adults and pediatric members of the task force. In that meeting, the preliminary results of the four SLRs were presented.

 In the adult group, the convenor proposed the texts of each recommendation. Each recommendation was discussed within the group, until an agreement was reached.

In the second portion of the same meeting, the two groups reviewed the two sets of recommendations, to verify if there were no major differences between the recommendations.

The results of the SLRs are reported in two articles, submitted for publication.