Abstract
One of the main causes of morbidity and mortality in patients with autoimmune rheumatic diseases (ARD) is acute and chronic infections. Several publications from our group reinforce the greater susceptibility, worse course and prognosis of various infectious diseases caused by viruses, bacteria and opportunistic agents (fungi and tuberculosis) in patients with ARD. Vaccination is the most effective and highly recommended measure to prevent infections in these patients and our group has also led internationally in recent years several prospective studies on immunization with significant populations of ARD. However, there are still important gaps about the mechanisms of humoral, cellular and innate immunity and the duration of vaccine protection (antibody decay). The impact of disease activity and the use of immunosuppressive drugs/biological agents in the vaccine response, as well as the effectiveness of strategies to increase the response, such as the suspension of immunosuppressive drugs and physical activity, for several vaccines [yellow fever (AF), meningococcal serogroup B and pneumococcal 13/23] are still lacking. Additionally, there are no randomized controlled studies in the literature with prophylactic treatments for the prevention of recurrent herpes simplex or for the prevention of post-extraction infections. In addition, there is no evidence on the control of vaginitis sicca, known to be involved in candidiasis, nor on the relevance of repeated screening for latent tuberculosis, as well as the rate of colonization by Pneumocystis jirovecii, as infection prevention strategies in patients with ARD. This thematic project, with 10 subprojects, has as an innovative proposal to expand the knowledge of strategies for the prevention of infectious diseases in ARD, including diagnostic improvement, prophylactic treatments, and assessment of humoral, innate, and cellular immunities for vaccines not yet included in the National Program. of immunizations for this population. It is hoped that the results of these studies will provide a basis for updating the recommendations of these vaccines for patients with ARD in the international and national immunization guidelines of specialized societies. Likewise, diagnostic improvement and prophylactic treatment protocols may be included in clinical practice with a view to reducing morbidity and mortality in these patients. (AU)
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