Rheumatic manifestations of hepatitis

Rheumatic manifestations are commonly encountered in patients with hepatitis B virus (HBV) or C (HCV) infection. In this review the most common clinical rheumatic manifestations of HBV or HCV infection and their management will be critically presented with a special emphasis on the efficacy and safety of the new biologic agents.

Recent significant advances in the antiviral therapy of chronic hepatitis B and C as well as the emergence of new biologic therapies (anti-TNF agents, rituximab) for the treatment of rheumatic diseases have changed significantly the therapeutic approach for patients with rheumatic disorders in the setting of hepatitis B or C. For patients with hepatitis B, prophylactic antiviral therapy with oral antiviral agents (nucleoside or nucleotide analogues) is recommended for all cases in which immunosuppressive therapies are administered, whereas for severe hepatitis C-associated mixed cryoglobulinemia, a number of recent studies have shown the short-term safety and efficacy of rituximab.

Rheumatologists in collaboration with hepatologists have today an array of efficacious therapeutic options to explore for patients presenting with rheumatic disorders in the setting of a co-existent HBV or HCV infection. Appropriate pretreatment screening and close monitoring are essential for these difficult-to-treat patients.