[Management of difficult clinical situations in rheumatoid arthritis: hepatitis]

Treatment of patients with Rheumatoid Arthritis (RA) who also present a chronic infection by the hepatitis B or C virus represents a therapeutic challenge due to the possibility that treatments used for RA can aggravate or reactivate hepatitis, either due to the drugs hepatic toxicity or the increase in viral replication after immunosuppresive treatment. The problem of reactivation of hepatitis has assumed a larger importance in the past 5 years with the publication of several cases of reactivation of hepatitis B associated with anti-TNF therapy. In this article we revise both problems, hepatotoxicity and the increase of viral replication, as well as the better strategies to treat these patients.