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Letter to the Editor
Comments: Recommendations for prevention of infection in systemic autoimmunerheumatic diseases
Comentario a: Recomendaciones SER sobre prevención de infección en enfermedades reumáticas autoinmunes sistémicas
Silvia Suárez-Díaza,
Corresponding author
silvia_porto@hotmail.es

Corresponding author.
, Luis Caminal-Monterob
a Servicio de Medicina Interna, Hospital Valle del Nalón, Langreo, Asturias, Spain
b Servicio de Medicina Interna, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the excellent systematic review by R&#250;a-Figueroa Fern&#225;ndez de Larrinoa et al&#46;&#44; representing SER experts and published in Reumatolog&#237;a Cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on the prevention of infections in systemic autoimmune rheumatic diseases&#46; We would like to make a few remarks in connection with these general recommendations&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Prophylaxis is recommended with trimethoprim&#47;sulfa metoxazole &#40;TMP&#47;SMX&#41; at a dose of 400&#47;80<span class="elsevierStyleHsp" style=""></span>mg per day against <span class="elsevierStyleItalic">Pneumocystis jirovecii</span> in patients with systemic autoimmune rheumatic diseases treated continuously with doses of glucocorticoids &#8805;20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; These recommendations may lead to error&#44; given that the tablets commercialized in Spain under the name Septrin&#174; contain 80<span class="elsevierStyleHsp" style=""></span>mg TMP and 400<span class="elsevierStyleHsp" style=""></span>mg SMX&#44; while Septrin Forte&#174; are twice this dose&#58; TMP 160&#47;SMX 800&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand&#44; we consider that it may be of interest to include recommendations in case of latent tuberculous infection outside treatments with anti-TNF&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This subject was recently raised in other journals in a general sense&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> where the specific advice was to routinely apply the IGRA test for all patients received glucocorticoids at an equivalent dose to prednisone 2<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day&#44; 15<span class="elsevierStyleHsp" style=""></span>mg per day during at least one month&#44; or other immunosuppressant medication&#46; Nevertheless&#44; when indicating prophylactic treatment for a latent tuberculous infection recommendations are less strict&#46; They propose indicating treatment only after a risk&#47;benefit analysis and evaluation of possible interactions and the risk of hepatotoxicity&#44; without considering the specific risk of the different synthetic or biological immunosuppressant drugs or reviewing the evidence for this&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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