Ann Rheum Dis 62:686-687 doi:10.1136/ard.62.7.686
  • Letter

Hepatitis B reactivation in a chronic hepatitis B surface antigen carrier with rheumatoid arthritis treated with infliximab and low dose methotrexate

  1. P Ostuni,
  2. C Botsios,
  3. L Punzi,
  4. P Sfriso,
  5. S Todesco
  1. Division of Rheumatology, Department of Medical and Surgical Sciences, School of Medicine, University of Padua Italy
  1. Correspondence to:
    Dr P Sfriso, Division of Rheumatology, via Giustiniani 2, 35128, Padova Italy;
  • Accepted 19 December 2002

Infliximab, a humanised, mouse derived, genetically engineered, monoclonal antibody to tumour necrosis factor α (TNFα), is successfully used in association with low dose methotrexate in the treatment of rheumatoid arthritis (RA).1 Serious infections have been reported to be associated with infliximab treatment.1,2 However, the safety of infliximab is unknown or has not been yet established in chronic viral infections, including human immunodeficiency virus, hepatitis B virus (HBV) or hepatitis C virus infections. We describe a case, from our cohort of 102 patients treated with infliximab plus methotrexate, who carried hepatitis B surface antigen (HBsAg) and subsequently developed acute hepatitis due to HBV reactivation after 16 months of treatment with infliximab.


A 49 year old man was diagnosed as having RA in January 1990. HBsAg, and HBe and HBc antibodies were positive, while HBe antigen and HBs …