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Epidemiological characteristics of hepatitis B and C in patients with inflammatory arthritis: Implications from
Emine Duygu Ersözlü1, Mustafa Ekici2, Belkis Nihan Coşkun3
1Department of Internal Medicine, Division of Rheumatology, Adana City Training and Research Hospital, Adana, Türkiye.
Insights
This study found low rates of hepatitis B and C in patients with rheumatoid arthritis or spondyloarthritis receiving biological treatments. Hepatitis B reactivation was rare, highlighting the importance of screening and prophylaxis in these patients.
Area of Science:
- Rheumatology
- Infectious Diseases
- Epidemiology
Background:
- Patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) often receive immunosuppressive biological treatments.
- Screening for viral hepatitis, including hepatitis B (HBV) and C (HCV), is crucial before initiating these therapies to prevent reactivation and manage patient care.
- Understanding the prevalence and characteristics of viral hepatitis in these patient populations is essential for effective clinical management.
Purpose of the Study:
- To determine the frequency and clinical characteristics of HBV and HCV infections in patients with RA and SpA undergoing biological treatments.
- To analyze patient demographics, comorbidities, and treatment patterns in relation to viral hepatitis status.
- To provide updated epidemiological data from a large, prospective registry in rheumatology practice.
Main Methods:
- An observational study utilizing data from the prospective TReasure database (December 2017-June 2021).
- Analysis included 3,147 RA patients and 6,071 SpA patients from 17 centers in Türkiye.
- Data collected covered viral hepatitis screening, patient characteristics, and biological disease-modifying antirheumatic drugs (bDMARDs) used.
Main Results:
- HBV screening rates were high (97% in RA, 94.2% in SpA).
- Hepatitis B surface antigen (HBsAg) positivity was 2.6% in RA and 2% in SpA. Antibody against HCV positivity was 0.8% in RA and 0.3% in SpA.
- HBsAg-positive patients were older, had more comorbidities (hypertension, diabetes, coronary artery disease), and higher rheumatoid factor positivity. One case of HBV reactivation occurred in an RA patient on rituximab with tenofovir prophylaxis.
Conclusions:
- The study provides current epidemiological data on viral hepatitis in RA and SpA patients on biologicals from the TReasure registry.
- Low prevalence of active HBV and HCV infections was observed, but HBsAg-positive patients had significant comorbidities.
- Effective patient management requires understanding these epidemiological characteristics and implementing appropriate screening and prophylactic measures.
Objectives:
This study aimed to evaluate the hepatitis B (HBV) and C (HCV) frequency and clinical characteristics among patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) who receive biological treatments.
Patients And Methods:
The observational study was conducted with patients from the TReasure database, a web-based prospective observational registry collecting data from 17 centers across Türkiye, between December 2017 and June 2021. From this database, 3,147 RA patients (2,502 males, 645 females; median age 56 years; range, 44 to 64 years) and 6,071 SpA patients (2,709 males, 3,362 females; median age 43 years; range, 36 to 52 years) were analyzed in terms of viral hepatitis, patient characteristics, and treatments used.
Results:
The screening rate for HBV was 97% in RA and 94.2% in SpA patients. Hepatitis B surface antigen (HBsAg) positivity rates were 2.6% and 2%, hepatitis B surface antibody positivity rates were 32.3% and 34%, hepatitis B core antibody positivity rates were 20.3% and 12.5%, HBV DNA (deoxyribonucleic acid) positivity rates were 3.5% and 12.5%, and antibody against HCV positivity rates were 0.8% and 0.3% in RA and SpA patients, respectively. The HBsAg-positive patients were older and had more comorbidities, including hypertension, diabetes, and coronary artery disease. In addition, rheumatoid factor (RF) positivity was more common in HBsAg-positive cases. The most frequently prescribed biologic disease-modifying antirheumatic drugs were adalimumab (28.5%), etanercept (27%), tofacitinib (23.4%), and tocilizumab (21.5%) in the RA group and adalimumab (48.1%), etanercept (31.4%), infliximab (22.6%), and certolizumab (21.1%) in the SpA group. Hepatitis B reactivation was observed in one RA patient during treatment, who received rituximab and prophylaxis with tenofovir.
Conclusion:
The epidemiological characteristics of patients with rheumatic diseases and viral hepatitis are essential for effective patient management. This study provided the most recent epidemiological characteristics from the prospective TReasure database, one of the comprehensive registries in rheumatology practice.
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