Managing patients with autoimmune inflammatory rheumatic diseases
(Part 4)
The vaccination status and the need for further vaccination in patients with autoimmune inflammatory rheumatic diseases (AIIRD) should be assessed annually by a rheumatologist.
The annual assessment is a key overarching principle rather than a recommendation.
The current practice emphasizes the need for a yearly assessment by the rheumatologist.
The rheumatologist has the knowledge and expertise on all aspects of AIIRD, including related treatment give to a patient.
For patients with AIIRD, the doctor coordinates a multidisciplinary approach.
The vaccine program should be explained to the patient by the doctor to come up with a joint decision regarding the treatment.
Shared decision making looks at the considerations of patient’s needs, and concerns.
There is a need to identify the fears and concerns of the patient regarding adverse effects.
Having access to evidence-based data about vaccines and information about risks and benefits of vaccination, gives patients an opportunity to make a decision regarding the impact of vaccination.
The doctor needs to inform patients about the risk of infections and the indications for vaccinations, educate patients about the risk/benefit ratio of vaccines and encourage patients to get vaccinated.
A sizable survey of rheumatoid arthritis (RA) patients in the United Kingdom shows that the majority of vaccination was taken in primary care, supports the collaboration between primary and secondary care to maximize vaccine reception.
The number of studies involving AIIRD patients immunized at the active disease stage is too low to draw the conclusion that vaccinations during active phases of disease are effective or safe.
Vaccines should be preferably administered prior to planned immunosuppression, in particular B cell depleting therapy
It is important not to delay necessary immunosuppressive treatment in severe cases.