[Rheumatoid arthritis and viral hepatitis]

Hepatitis B virus (HBV) reactivation during immunosuppressive therapy is responsible for severe liver injuries in patients with persistent HBV infection. Serological examination for HBV infection is necessary before starting immunosuppressive therapy for all patients with rheumatoid arthritis. Japanese College of Rheumatology recommends that all patients should be screened for HBs antigen before immunosuppressive therapy. Then those who are negative for HBs antigen should be tested for anti-HBs and anti-HBc antibodies. HBV DNA quantification using real-time PCR should be performed in patients with resolved HBV infection a one to three months interval. HBV reactivation typically occurs within six months of the start of immunosuppressive therapy in patients with resolved HBV infection Prophylaxis with nucleos (t) ide analogs is recommended if patients are HBs antigen positive or HBV DNA positive. Further studies are needed to reconcile safety with cost-effectiveness because patients with rheumatoid arthritis receive various immunosuppressive therapies throughout their lives.