http://ard.bmj.com/content/early/2013/12/11/annrheumdis-2013-203848?papetoc

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The emerging problem of biological treatment in migrant and travelling populations: it is time to extend guidelines for the screening of infectious diseases
F Bartalesi1,2, A Bartoloni1,2, Z Bisoffi2,3, M Spinicci1,2, F Giménez Sánchez4,5, J Muñoz5,6, P Richi7,8, G Minisola9,10, S Muñoz-Fernandez7,8, M Matucci-Cerinic10,11
+ Author Affiliations

1Division of Infectious and Tropical Diseases AOUC, Department of Experimental and Clinical Medicine, Italian Society of Tropical Medicine (SIMET), University of Florence, Florence, Italy
2Italian Society of Tropical Medicine (SIMET)
3Centre for Tropical Diseases, Ospedale Sacro Cuore, Negrar, Verona, Italy
4Pediatric Infectious Diseases Unit, Spanish Society of Tropical Medicine and International Health (SEMTSI), Hospital of Torrecardenas, Almeria, Spain
5Spanish Society of Tropical Medicine and International Health (SEMTSI)
6Barcelona Centre for International Health Research, Hospital Clinic, Barcelona, Spain
7Spanish Society of Rheumatology (SER)
8Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Spain
9Rheumatology Unit, S Camillo Hospital, Rome, Italy
10Italian Society for Rheumatology (SIR)
11Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
Correspondence to
Professor Marco Matucci-Cerinic, Division of Rheumatology, Department of Biomedicine, and Department of Experimental and Clinical Medicine, Italian Society of Rheumatology (SIR), University of Florence, Florence 50139, Italy; cerinic@unifi.it
Received 28 April 2013
Revised 27 September 2013
Accepted 24 November 2013
Published Online First 11 December 2013
Abstract
The use of biological agents in the treatment of rheumatic diseases has been widely associated with an increased risk of reactivation of several latent infections. National and international guidelines recommend screening for infectious diseases before starting these drugs. In Western countries screening is limited to latent tuberculosis infection, HIV and viral hepatitis. However, the increasing globalisation and the remarkable number of migrating and travelling people worldwide make this approach no longer adequate. The Italian and Spanish Societies of Rheumatology and Tropical Medicine wish to issue a warning about the need to improve awareness of doctors about the risk of reactivation of infectious tropical diseases in migrant or travelling patients who undergo biological therapy. Thus, the Italian and Spanish Societies are now planning to issue specific recommendations, based on a multidisciplinary contribution and a systematic review of the literature, for screening and follow-up of active and latent chronic infections in candidate patients for biological agents, taking into account the patient's area of origin and risk of infectious diseases.
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