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Vol. 19. Issue 3.
Pages 174 (March 2023)
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Vol. 19. Issue 3.
Pages 174 (March 2023)
Letter to the Editor
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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

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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Dear Editor,

We read with interest the excellent systematic review by Rúa-Figueroa Fernández de Larrinoa et al., representing SER experts and published in Reumatología Clínica1 on the prevention of infections in systemic autoimmune rheumatic diseases. We would like to make a few remarks in connection with these general recommendations.

Prophylaxis is recommended with trimethoprim/sulfa metoxazole (TMP/SMX) at a dose of 400/80mg per day against Pneumocystis jirovecii in patients with systemic autoimmune rheumatic diseases treated continuously with doses of glucocorticoids ≥20mg/day. These recommendations may lead to error, given that the tablets commercialized in Spain under the name Septrin® contain 80mg TMP and 400mg SMX, while Septrin Forte® are twice this dose: TMP 160/SMX 800.2

On the other hand, we consider that it may be of interest to include recommendations in case of latent tuberculous infection outside treatments with anti-TNF.3 This subject was recently raised in other journals in a general sense,4 where the specific advice was to routinely apply the IGRA test for all patients received glucocorticoids at an equivalent dose to prednisone 2mg/kg/day, 15mg per day during at least one month, or other immunosuppressant medication. Nevertheless, when indicating prophylactic treatment for a latent tuberculous infection recommendations are less strict. They propose indicating treatment only after a risk/benefit analysis and evaluation of possible interactions and the risk of hepatotoxicity, without considering the specific risk of the different synthetic or biological immunosuppressant drugs or reviewing the evidence for this.

Conflict of interests

The authors have no conflict of interests to declare.

Í Rúa-Figueroa Fernández de Larrinoa, P.E. Carreira, N. Brito García, P. Díaz Del Campo Fontecha, J.M. Pego Reigosa, J.A. Gómez Puerta, et al.
Recommendations for prevention of infection in systemic autoimmune rheumatic diseases.
Reumatol Clin (Engl Ed), S1699-258X (2021), pp. 00124-00128
Agencia Española de Medicamentos y Productos Sanitarios. Ficha técnica Septrin. (Consultado el 15 de Agosto de 2022.). Available from:
I. Mir Viladrich, E. Daudén Tello, G. Solano-López, F.J. López Longo, C. Taxonera Samso, P. Sánchez Martínez, et al.
Consensus document on prevention and treatment of tuberculosis in patients for biological treatment.
Arch Bronconeumol., 52 (2016), pp. 36-45
M. Shah, S.E. Dorman.
Latent tuberculosis infection.
N Engl J Med., 385 (2021), pp. 2271-2280
Copyright © 2022. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología
Reumatología Clínica (English Edition)
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