Article Text

AB0319 Reactivation of Hepatitis B Virus in Patients with Rheumatoid Arthritis
  1. H. Iwase,
  2. Y. Kanayama,
  3. H. Inagaki,
  4. A. Murase,
  5. M. Saeki,
  6. S. Shimizu,
  7. T. Saeki,
  8. M. Murata
  1. Orthopdeic Surgery and Rheumatology, Toyota Kosei Hospital, Toyota, Japan


Background The risk of the HBV reactivation in patients who receive immunosuprressive therapy was pointed out these days. The frequency of the patients over 50 years old with resolver hepatitis B virus in our country is 20–25%, and it is difficult in medical economics to carry out preventional medication of nucleic acid analog to all the patients.The guidline against HBV developed by immunosuppression, chemotherapy (2013) was published by the Japan society of hepatology, which said that if anti-HBs or anti-HBc is positive,HBV-DNA and ALT/AST should be observed every one-three mouths, and the dosage of the nucleic acid analog is recommended if HBV-DNA is more than 2.1log copies/mL. HBV-DNA monitoring situation in our department was examined this time.

Methods In our department, 134 patients are under medical treatment of RA. 38 RA patients were positive either anti-HBs or anti- HBc. We enrolled 22 patients with RA (8 men and 14 women) who had anti-HBs or anti HBc and who had received treatment with anti rheumatic drugs,including biological drugs.The average age was 64 years old. The monitoring span of HBV-DNA quantity and the generating situation of HBV reactivation were examined.

Results In the first-time inspection, HBV-DNA had not detected in all patients and monitoring was performed in every 4-8 weeks. The average monitoring interval was every 5.2 weeks. The average monitoring period was 10.7 months. Although very-small-quantity of HBV-DNA (<2.1 log copies/mL) was observed twice in one patient medicated with methotrexate (MTX) and mizoribine (MZB) and infliximab (IFX),after entecavir medication started, HBV-DNA was undetected promptly, and re-detectation was not seen and did not show the rise of AST and ALT, either.

Conclusions We experienced one patient who developed reactivation of HBV-DNA during HBV-DNA monitoring. It was expected that the risk of HBV revitalization was high for this patient,because immunosuppressant and biological medicine were given. But as a result of monitoring of HBV-DNA for every month, HBV-DNA was able to detect in a little stages. RA patients with resolver hepatitis B virus should be monitored based on guideline.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.2867

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