Infectious disease screening in rheumatological patients: a narrative review on methods, risk stratification and clinical management

INTRODUCTION: Infectious disease screening is now a routine component in the management of patients with rheumatological conditions and is mandatory in some settings before initiating biologic or conventional immunosuppressive therapies. AREAS COVERED: In this narrative review, we summarize the current literature to assist clinicians in interpreting screening results and risk stratification, and to guide subsequent clinical management, including prophylaxis, monitoring, and treatment strategies. The review of the literature was performed using MEDLINE and Embase, complemented by manual searches of reference lists and gray literature, to identify evidence on infectious disease screening in patients with rheumatologic conditions undergoing immunosuppressive therapy. EXPERT OPINION: Available evidence supports the importance of effective pre-treatment screening and risk assessment in patients requiring immunosuppression. However, significant knowledge gaps remain, particularly regarding infectious risks linked to certain drug classes and the optimal implementation of screening strategies.