2023-11-24 12:27:56
People with rheumatic diseases must be vaccinated against the main preventable infections in a personalized program coordinated by the rheumatologist specialist. This is the appeal launched by the Italian Society of Rheumatology (Sir) on the occasion of its 60th National Congress underway in Rimini. “It is essential to avoid certain pathologies which for a rheumatic patient can be much more dangerous than for the rest of the population – states Gian Domenico Sebastiani, president of SIR – There is extensive scientific literature which has unequivocally demonstrated how rheumatological diseases are responsible of more severe infections. The risk of hospitalizations for seasonal flu is also higher. Or, especially among people affected by rheumatoid arthritis – explains Sebastiani – the pneumococcus can cause serious pneumonia or even a heart attack. For patients affected by systemic lupus erythematosus, there is an increased risk of HPV infection (Papilloma Virus, ed.). In Italy” there are over 27 thousand people with Lupus “and, in the vast majority, these are adult women who were not immunized against the virus when young”.
The vaccination process “must take into account some fundamental aspects – continues Sebastiani – such as age, the level of immunosuppression, the presence of any other diseases or the type of therapy taken. The rheumatologist has the task of guiding the entire process, prescribing vaccines and, in particular, indicating methods and timing that must be compatible with the treatments. However, there are some general rules – recalls President Sir – For example, all vaccines must be administered in the clinical remission phases of the disease. Live vaccines are generally contraindicated and only if necessary they should be administered at least 4 weeks before starting immunosuppressive therapy.”
From the most important annual event, the Scientific Society renews its invitation to all fragile patients to be vaccinated against Covid. “The rheumatology patient must be protected as much as possible against Sars-CoV-2 – adds Nicola Ughi, medical director at the Rheumatology of the Asst Grande metropolitano Niguarda hospital in Milan – We recommend to everyone the fifth dose which will be available, in some Regions, for the entire population regardless of age or the presence of serious chronic diseases. In the healthcare facilities of the Peninsula we are witnessing an increase in cases of people hospitalized due to Coronavirus-19. It is a real danger which however we can avoid thanks to immunisation”.
In this regard, “like Sir – observes Carlo Alberto Scirè, associate professor of Rheumatology at the Bicocca University of Milan – we were the first in Europe to start a register on Covid and rheumatological diseases. From 2020 to 2021 we involved and collected the data of more than 1,800 patients with the aim of evaluating the outcomes of the infection compared to the general population. We have found – explains the professor – how the risk of contracting Covid is slightly greater while the prognosis is worse. There are higher rates of hospitalizations or resort to intensive care in particular for the most severe rheumatological diseases”. As underlined by President Sebastiani, “patients undergoing immunosuppressive treatment may not respond adequately to vaccination. In addition to vaccination – he clarifies – therapies based on monoclonal antibodies that can protect the immunocompromised patient and protect him from the risk of severe forms of Covid-19”.
Vaccinations represent an “extremely effective tool for the prevention and control of many diseases – reiterates Andrea Doria, president-elect of SIR – Immunization rates must therefore be increased, which are currently still low and not only for our patients. Suffice it to say that in the entire Italian population only 20% are vaccinated against the flu season, which is instead strongly recommended for all rheumatology patients and caregivers. The advent of biological drugs, over twenty years ago – highlights Doria – has greatly increased the prospects of treatment for serious pathologies which until then were also fatal. For this reason we must take an ever greater interest in the health of patients at 360 degrees and therefore also in the prevention of infections. For example, the risk of Herpes zoster is even triple and the possible complications are numerous. It is estimated that approximately 30% of rheumatology patients who contract shingles virus infection even suffer a brain stroke. Now – remember – we have a new recombinant vaccine available, therefore a protein. It can also be administered to those who are receiving immunosuppressant-based therapies without having to interrupt treatment.”
The national congress – 60 sessions and 6 Hands On attended by over 1,500 specialists and 160 speakers – is also an opportunity to take stock of scientific research. “In our country there are active centers of absolute excellence for research on rheumatological diseases – concludes Ennio Lubrano di Scorpaniello, SIR vice-president – Among the various diseases, the most serious arthritis and various rare pathologies still significantly undermine the quality of life of a number growing number of men and women. There is therefore an absolute need to encourage studies and experiments for the development of new diagnostic and therapeutic tools”.
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