Background Chronic viral C hepatitis affects around 170 million people in the world. In some areas, prevalence is higher, it reaches 6% of the population of the urban district of Barika - Algeria. This constitutes a burden for the management of some affections, among them rheumatoid arthritis (RA) since some reports noted reactivation or worsening of viral C hepatitis under immunosuppressive therapies. Data concerning methotrexate in RA are scarce except few case reports, most of them were reassuring. We followed a cohort of patients presenting with RA associated with a Hepatitis C infection and treated with methotrexate (MTX), in order to detect any worsening or recurrence of their infection under methotrexate.
Methods Seven patients, all female, presenting with RA and chronic viral C hepatitis were enrolled in the study and followed up by a rheumatologist (SS) and a specialist in infectious diseases (SB). Mean age was 56.7 years and mean duration of RA 12 years. They all had an RA according to the 2010 ACR/EULAR criteria. They had a positive HCV test (Elisa confirmed by an ImmunoBlot). Methotrexate was given only when real-time PCR for HCV was negative, either initially or after a 48 week Interferon alpha + Ribavirine therapy. Moreover, patients with histological grading ≥ A2F2 were not included. A screening was established as follows: liver enzymes every 2 months, bilirubine and HCV PCR at 6 months from MTX initiation. A control group was created with 30 female RA patients, HCV-, matched for age and MTX doses. Liver enzymes levels were compared at M0 and M6 in HCV+ group and between HCV- and HCV+ groups by a Student T-test. Results were considered significant for p<0.05.
Results Are presented here the preliminary results. Mean follow-up duration under MTX was 7 months. Mean MTX dosage 14 mg/week. Six/seven patients achieved a EULAR response to MTX at M6, the mean reduction for DAS28 in the seven patients at M6 was significant (p=0.035). Liver enzymes levels were stable between M0 and M6 (p=0.845) and no patient had presented levels >1.5 upper normal limit during the screening period. PCR HCV remained negative at M6 for the 7 patients and bilirubine remained in normal ranges. Comparison in liver enzymes levels at M6 between PR HCV+ and PR HCV- groups did not find differences (p=0.693).
Conclusions In our series of 7 patients presenting with a non-active C hepatitis and treated with methotrexate, we have not observed any reactivation of HCV during a 7 months follow-up. Results are preliminary because more patients are being included and a longer follow-up period is expected. Our results are reassuring and suggest that RA patients having HCV+ and HCV PCR- tests could be treated with MTX, but a tight control for liver enzymes and regular HCV PCR screening should be performed.
Disclosure of Interest None Declared