Vaccination in chronic autoimmune and inflammatory rheumatic diseases

Infekcije koje se mogu prevenirati cijepljenjem značajno se češće javljaju u bolesnika s kroničnim autoimunim i upalnim reumatskim bolestima u odnosu na opću populaciju. Većina je cjepiva imunogenična, učinkovita i sigurna u ovih bolesnika, čak i uz primjenu imunosuprimirajućih lijekova, izuzevši rituksimab. Živa atenuirana cjepiva ne treba primjenjivati u bolesnika koji se dugotrajno liječe imunosupresivnim lijekovima. Pojavnost neželjenih reakcija te autoimunih fenomena ne razlikuje se bitno između cijepljenih bolesnika s reumatskim bolestima i cijepljenih zdravih pojedinaca. Potrebna su iscrpnija istraživanja sigurnosti cjepiva i utjecaja novih imunomodulirajućih lijekova na učinkovitost cjepiva jer su dosadašnja uglavnom retrospektivna i provedena na malim uzorcima bolesnika. Preporuke o cijepljenju temeljene na dokazima koje je donijela Europska liga protiv reumatizma (EULAR-a) značajno će pomoći reumatolozima u odluci o cijepljenju svojih bolesnika.Vaccine preventable infections occur more often in patients with autoimmune and chronic rheumatic diseases when compared to the general population. Most vaccines are immunogenic, efficacious and safe in those patients, even with immunosuppressive treatment, excluding rituximab. Live attenuated vaccines should be avoided in patients receiving long-term immunosuppressive therapy. The occurrence of adverse events and autoimmune phenomena is almost the same in vaccinated patients with rheumatic diseases and in vaccinated healthy individuals. A deeper research is needed regarding safety of vaccination and the influence of new immunomodulating drugs on efficacy of vaccination since the studies that were undertaken so far are retrospective or performed on small cohorts of patients. Evidence-based recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases developed by European League Against Rheumatism (EULAR) will help rheumatologists in making a decision about vaccinating their patients