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Recommendations for Infectious Disease Screening in Migrants to Western Europe with Inflammatory Arthropathies Before Starting Biologic Agents

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Recommendations for Infectious Disease Screening in Migrants to Western Europe with Inflammatory Arthropathies Before Starting Biologic Agents Recommendations for infectious disease screening in migrants to Western Europe with inflammatory arthropathies before starting biologic agents. Results from a multidisciplinary task force of four European societies (SIR, SER, SIMET, SEMTSI) facing the largest impact of the flow of migrants today F. Bartalesi1, C.A. Scirè2, A. Requena-Méndez3, M.A. Abad4, D. Buonfrate5, R. Caporali6, F. Conti7, F. Diaz-Gonzalez8, C. Fernández-Espartero9, C. Martinez-Fernandez10, M. Mascarello11, E. Generali12, G. Minisola12, A. Morrone13, J. Muñoz3, P. Richi14, G. Sakellariou6, J. Salas Coronas14, M. Spinicci1, F. Castelli15, A. Bartoloni1, Z. Bisoffi5, F. Gimenez-Sanchez16, S. Muñoz Fernández14, M. Matucci-Cerinic17 1SOD Malattie Infettive e Tropicali, Careggi Hospital, Florence, Italy; 2Rheumatology Unit, Dept. of Medical Sciences, University of Ferrara, and Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy; 3Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic, Universitat de Barcelona, Spain; 4Division of Rheumatology, Hospital Virgen del Puerto, Plasencia, Spain; 5Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar, Verona, Italy; 6Division of Rheumatology, University of Pavia, IRCCS S. Matteo Foundation, Pavia, Italy; 7Dept. of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University, Rome, Italy; 8Dept. of Medicine, Universidad de La Laguna, Division of Rheumatology, Hospital Universitario de Canarias, La Laguna, Spain; 9Servicio de Reumatologia, Hospital Universitario de Mostoles, Madrid; 10Research Unit, Spanish Society of Rheumatology, Madrid, Spain; 11Infectious Diseases Unit, University Hopital of Trieste, Italy; 12Division of Rheumatology, San Camillo Hospital, Rome, Italy; 13General Directorate, San Camillo Hospital, Rome, Italy; 14Division of Rheumatology, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain; 15University Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili General Hospital, Italy; 16Unidad de Vacunación Internacional, Instituto Hispalense de Pediatría, Granada, Spain, Spanish Society of Tropical Medicine and International Health; 17Dept. of Experimental and Clinical Medicine, Div. Rheumatology AOUC, University of Florence, Italy. Abstract Objective Inflammatory arthritis needs infectious disease screening before starting a biologic agent, however, few data are known about migrant patients, who represent a peculiar population which requires a multidisciplinary approach among international health specialists and should also be considered by health authorities. For this reason, the Italian and Spanish Societies of Rheumatology (SIR and SER) and Tropical Medicine (SIMET and SEMTSI) promoted a multidisciplinary task force in order to produce specific recommendations about screening and advices to be considered in migrant patients with inflammatory arthritis candidate to receive biological therapy, according to their geographical origin. Methods The experts provided a prioritised list of research questions and the eligible spectrum of inflammatory arthritis, biologic drugs and infectious disease were defined in order to perform a systematic literature review. A search was made in Medline, Embase and Cochrane library, updated to March 2015. Ubiquitous infections and HBV, HCV, HIV and tuberculosis that are already considered in national and international recommendations, were not included. The strength of each recommendation was determined. Results The task force members agreed on 7 overarching principles. The risk of reactivation of selected potentially latent infectious disease was addressed in migrants with inflammatory arthritis candidates for biologics was considered and 15 potentially relevant infections were identified. Conclusion Fifteen disease-specific recommendations were formulated on the basis of high level of agreement among the experts panel. Key words rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, anti-TNF, infections, systematic review Clinical and Experimental Rheumatology 2017 Recommendations for infectious disease screening in migrants / F. Bartalesi et al. Filippo Bartalesi, Carlo A. Scirè, Introduction reactivation of unusual infections, for Ana Requena-Méndez, Miguel Angel Abad, The use of biological agents has grown which screening is not routinely pro- Dora Buonfrate, Roberto Caporali, exponentially in rheumatology and vided, has been reported (4). Fabrizio Conti, Federico Diaz-Gonzalez, other specialties. In rheumatic dis- The correct management of patients Cruz Fernández-Espartero, Carmen Martinez-Fernandez, eases, biological treatments have been coming from endemic areas for endem- Marta Mascarello, Elena Generali, largely used in inflammatory arthriti- ic, tropical and/or neglected disease Giovanni Minisola, Aldo Morrone, des (IA) such as rheumatoid arthritis who undergo biological treatment is a Jose Muñoz, Patricia Richi, (RA), psoriatic arthritis (PsA) and an- problem, which deserves consideration Gariffalia Sakellariou, Joaquin Salas kylosing spondylitis (AS), contributing by rheumatologists. While in these cas- Coronas, Michele Spinicci, to control disease progression and im- es a global work up of several diseases Francesco Castelli, Alessandro Bartoloni, proving patients’ quality of life. Their is not feasible, screening strategies and Zeno Bisoffi, Francisco Gimenez-Sanchez, Santiago Muñoz Fernández, use has revealed an increased risk of clinical monitoring can be personalised Marco Matucci-Cerinic serious adverse events, fostering new according to the region of origin. Please address correspondence to: infectious events and, mostly, reactiva- In this regard, in accordance with the Marco Matucci-Cerinic, MD, PhD, tion of chronic/latent infectious diseas- new concept of global health, a multi- Division of Rheumatology, es (1). Granulomatous infections are disciplinary approach among interna- Department of Experimental widely documented in patients treated tional health specialists is a fundamen- and Clinical Medicine, with biological agents, especially anti- tal but there is still the unmet need to Villa Monna Tessa, TNF-α inhibitors, thus suggesting a approach problems in migrant patients Viale Pieraccini 18, class effect (2). For this reason, screen- that health authorities should consider. 50139 Firenze, Italy. E-mail: [email protected] ing for active and latent chronic infec- For this reason, the Italian and Spanish Received on November 11, 2016; accepted tious diseases in patients who are can- Societies of Rheumatology (SIR and in revised form on January 23, 2017. didates for biological agents is manda- SER) and Tropical Medicine (SIMET tory. In developed countries, screening and SEMTSI) promoted a multidis- © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2017. for infectious diseases is generally lim- ciplinary task force in order to pro- ited to chronic viral hepatitis and latent duce specific recommendations about tuberculosis infection (LTBI). screening and advices to be considered Increasing globalisation and the re- in migrant patients with IA candidate to markable number of migrating and receive biological therapy, according travelling people worldwide makes this to their geographical origin. This aim approach no longer adequate. Migra- was achieved following standard oper- tion between different epidemiological ating procedures, combining available environments causes new challenges to evidence from medical literature with health systems, which must be taken in expert opinion (5). Our recommenda- account to ensure equitable access to tions target all physicians and nurses care and an early identification of the who are involved in the care for pa- various threats, risks and challenges tients with IA. of the migrant populations (3). In this framework, the new concept of global Materials and methods health is defined as ‘health without Expert committee borders’, to interpret and examine The committee consisted of 11 rheuma- the relationship between people and tologists, 10 tropical/infectious disease countries, based on globalisation and physicians, and 3 clinical epidemiolo- its impact on health. For this reason, gists, representing two European coun- new health-promotion programmes tries (Italy and Spain) that are currently and screening strategies for the preven- facing the largest wave of migrants. tion and control of infectious diseases are needed today, particularly because Definitions the reactivation of neglected latent in- In these recommendations, the term fections, due to underlying conditions, ‘migrant’ refers to people from coun- such as HIV infection, haematological tries/areas with negative net migration malignancies, solid-organ transplanta- index (Central/South America, Asia, Af- tion or immunosuppressive therapies, rica, Eastern Europe), migrated to West- Funding: this study received unrestricted may often result in severe and some- ern Europe (WE). WE was defined in funding from the Italian Society for times life-threatening manifestations accordance to United Nations Regional Rheumatology. and complications. Also, in the context Groups definition. IA include RA, PsA, Competing interests: none declared. of treatment with biological agents, AS and undifferentiated arthritides. 2 Recommendations for infectious disease screening in migrants / F. Bartalesi et al. Biologic drugs include anti-TNF-α Table I. Evidence categories and strength of recommendations. (infliximab, etanercept,
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