Marco Sebastiani1, Fabiola Atzeni2, Laura Milazzo3, Luca Quartuccio4, Carlo Scirè5, Giovanni Battista Gaeta6, Giovanni Lapadula7, Orlando Armignacco8, Marcello Tavio9, Ignazio Olivieri10, Pierluigi Meroni11, Laura Bazzichi12, Walter Grassi13, Alessandro Mathieu14, Claudio Mastroianni15, Evangelista Sagnelli16, Teresa Santantonio17, Caterina Uberti Foppa18, Massimo Puoti19, Loredana Sarmati20, Paolo Airò21, Oscar Massimiliano Epis22, Rossana Scrivo23, Miriam Gargiulo24, Agostino Riva3, Andreina Manfredi25, Giovanni Ciancio26, Gianguglielmo Zehender27, Gloria Taliani15, Luca Meroni3, Salvatore Sollima3, Piercarlo Sarzi-Puttini2, Massimo Galli3. 1. Rheumatology Unit, Department of Medical and Surgical Science, University of Modena, Azienda Policlinico of Modena, 71, Via del Pozzo, 41121 Modena, Italy. Electronic address: marco.sebastiani@unimore.it. 2. Rheumatology Unit, L. Sacco University Hospital, Milan, Italy. 3. Infectious Diseases Unit, University of Milano, Luigi Sacco Hospital, Milan, Italy. 4. Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Udine, Italy. 5. Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy. 6. Infectious Diseases and Viral Hepatitis Unit, Department of Internal and Specialistic Medicine, Second University of Naples, Naples, Italy. 7. Department of Medicine, Rheumatology Unit, Medical School, University of Bari, Bari, Italy. 8. Infectious Disease Unit, Belcolle Hospital, Viterbo, Italy. 9. Unit of Emerging and Immunosuppressed Infectious Diseases, Department of Gastroenterology and Transplantation, Azienda Ospedaliero, Universitaria "Ospedali Riuniti", Torrette Ancona, Italy. 10. Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy. 11. Division of Rheumatology, Department of Clinical Sciences and Community Health, Gaetano Pini Orthopedic Institute, University of Milan, Milan, Italy. 12. Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 13. Department of Rheumatology, Università Politecnica delle Marche, Ospedale "C. Urbani", Ancona, Italy. 14. Rheumatology Unit, University Clinic and AOU of Cagliari, Cagliari, Italy. 15. Infectious Diseases Unit, Department Public Health and Infectious Disease, "Sapienza" University of Rome, Rome, Italy. 16. Department of Mental Health and Public Medicine, Second University of Naples, Naples, Italy. 17. Clinic of Infectious Diseases, University of Foggia, Foggia, Italy. 18. Department of Infectious Diseases, San Raffaele Scientific Institute, Università Vita-Salute, Milan, Italy. 19. Department of Infectious Diseases, AO Niguarda Ca' Granda, Milano, Italy. 20. Clinical Infectious Diseases, Tor Vergata University, Rome, Italy. 21. Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, Brescia, Italy. 22. Rheumatology Unit, A.O. Ospedale Niguarda Cà Granda, Milan, Italy. 23. Department of Internal Medicine and Medical Specialties-Rheumatology Unit, Sapienza University of Rome, Rome, Italy. 24. Third Department of Infectious Diseases, D. Cotugno Hospital, AORN dei Colli, Naples, Italy. 25. Rheumatology Unit, Department of Medical and Surgical Science, University of Modena, Azienda Policlinico of Modena, 71, Via del Pozzo, 41121 Modena, Italy. 26. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Sant'Anna University Hospital, Ferrara, Italy. 27. Chair of Hygiene, University of Milan, Milan, Italy.
Abstract
OBJECTIVES: Hepatitis B (HBV) infection, which is prevalent worldwide, is also frequently seen in patients with rheumatoid arthritis (RA). The Italian Society of Rheumatology (SIR) and the Italian Society of Infectious and Tropical Diseases (SIMIT) endorsed a national consensus process to review the available evidence on HBV management in RA patients and to produce practical, hospital-wide recommendations. METHODS: The consensus panel consisted of infectious disease consultants, rheumatologists and epidemiologists and used the criteria of the Oxford Center for Evidence-based Medicine to assess the quality of the evidence and the strength of their recommendations. RESULTS: A core-set of statements has been developed to help clinicians in the management of patients with RA and HBV infection. Vaccination and prophylaxis of RA patients treated with biological drugs have been also discussed. CONCLUSIONS: HBV infection is not rare in clinical practice; a screening for HBV in all patients with early arthritis is not universally accepted, while it is considered mandatory before starting any immunosuppressive or hepatotoxic treatment. In fact, a specific risk, associated with the use of biologic treatments, exists for patients with HBV infection, although longitudinal studies of viral reactivation are generally reassuring. RA patients with HBV infection should be referred to the hepatologist and correctly classified into active or inactive carriers. Patients with active hepatitis B should undergo antiviral treatment before starting immunosuppressive treatments. Occult HBV carriers should be monitored or receive prophylaxis on the basis of the risk of reactivation associated with the administered treatment.
OBJECTIVES:Hepatitis B (HBV) infection, which is prevalent worldwide, is also frequently seen in patients with rheumatoid arthritis (RA). The Italian Society of Rheumatology (SIR) and the Italian Society of Infectious and Tropical Diseases (SIMIT) endorsed a national consensus process to review the available evidence on HBV management in RApatients and to produce practical, hospital-wide recommendations. METHODS: The consensus panel consisted of infectious disease consultants, rheumatologists and epidemiologists and used the criteria of the Oxford Center for Evidence-based Medicine to assess the quality of the evidence and the strength of their recommendations. RESULTS: A core-set of statements has been developed to help clinicians in the management of patients with RA and HBV infection. Vaccination and prophylaxis of RApatients treated with biological drugs have been also discussed. CONCLUSIONS:HBV infection is not rare in clinical practice; a screening for HBV in all patients with early arthritis is not universally accepted, while it is considered mandatory before starting any immunosuppressive or hepatotoxic treatment. In fact, a specific risk, associated with the use of biologic treatments, exists for patients with HBV infection, although longitudinal studies of viral reactivation are generally reassuring. RApatients with HBV infection should be referred to the hepatologist and correctly classified into active or inactive carriers. Patients with active hepatitis B should undergo antiviral treatment before starting immunosuppressive treatments. Occult HBV carriers should be monitored or receive prophylaxis on the basis of the risk of reactivation associated with the administered treatment.