The Italian Society of Rheumatology clinical practice guidelines for the management of vaccines in adult patients with rheumatic diseases

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OBJECTIVE: Rheumatic and musculoskeletal diseases (RMDs) represent a significant public health challenge in Italy. RMDs are often chronic and lead to increased morbidity and mortality, partly due to an increased risk of infections. Patients with RMDs and those on immunosuppressive therapy show a higher susceptibility to vaccine-preventable diseases and to serious complications in case of infection. Therefore, vaccination is a crucial tool to reduce these risks. This guideline was developed by the Italian Society of Rheumatology and aimed to provide updated national recommendations for clinical practice on vaccinations in adult patients with RMDs. METHODS: The GRADE ADOLOPMENT approach to combine adoption, adaptation, or de novo development of recommendations was used, and the 2022 American College of Rheumatology (ACR) guideline on vaccinations in RMDs was used as reference. The development process included an updated systematic review of the available evidence and an assessment of the ACR guidelines and their adaptability to the Italian context, followed by a discussion with experts in rheumatology and public health and representatives of healthcare professionals and patients. RESULTS: A set of recommendations was developed, and special attention was given to the current vaccination schedule and to the adjustment of anti-rheumatic drugs to optimize the response to vaccines. CONCLUSIONS: This guideline is a step forward in enhancing management and clinical practice for RMD patients in Italy and provides specific and evidence-based indications for infection prevention through vaccination. Their use is intended to promote health and alleviate the burden of morbidity and mortality in this vulnerable population.

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