Rheumatology meets hepatology in 2012: a clinician's guideline for TNF inhibitors in hepatitis B/C virus carriers.

Effective and less toxic biologics have revolutionized rheumatology as well as hepatology over the last decennia resulting in higher therapeutic goals. Traditional disease modifying anti-rheumatic drugs (tDMARDs) failing to achieve a quiescent chronic rheumatoid arthritis (RA) or spondylarthropathic arthritis (SA) inflammatory disease, nowadays are to be switched into a more potent strategy with ultimately a combination of tDMARD plus TNF inhibitors (TNFi) early in disease. Patients with previous microbiological infections however present a challenge for a modern rheumatologist aiming at complete remission, particularly in carriers of viral infections. Hepatologists nowadays, can treat chronic hepatitis B and C virus infections effectively with potent antivirals. In the current issue an overview is given regarding patients in whom TNFi may be indicated, but also have been infected with viral hepatitis.