Tohoku J. Exp. Med., 2014 June, 233(2)

Prevalence of Hepatitis B Virus Infection in Patients with Rheumatic Diseases in Tohoku Area: A Retrospective Multicenter Survey

RYU WATANABE,¹ TOMONORI ISHII,¹ HIROKO KOBAYASHI,² ICHIZO ASAHINA,³ HIROMITSU TAKEMORI,⁴ TOMOMASA IZUMIYAMA,⁵ YOSHITO OGUCHI,⁶ YUKITOMO URATA,⁷ TOMOE NISHIMAKI,⁸ KATSUMI CHIBA,⁹ ATSUSHI KOMATSUDA,¹⁰ NORIYUKI CHIBA,¹¹ MASAYUKI MIYATA,¹² MICHIAKI TAKAGI,¹³ OSAMU KAWAMURA,¹⁴ TAKASHI KANNO,¹⁵ YASUHIKO HIRABAYASHI,¹⁶ TSUNEO KONTA,¹⁷ YUKARI NINOMIYA,¹⁸ YOSHIYUKI ABE,¹⁹ YUHJI MURATA,²⁰ YOSHIHIRO SAITO,²¹ HIROMASA OHIRA,² HIDEO HARIGAE¹ and TAKESHI SASAKI²²

¹Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
²Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
³Yamagata Prefectural Central Hospital, Yamagata, Yamagata, Japan
⁴Aomori Prefectural Central Hospital, Aomori, Aomori, Japan
⁵Higashisendai Riumatikanaika Clinic, Sendai, Miyagi, Japan
⁶Oguchi Clinic, Koriyama, Fukushima, Japan
⁷Department of Rheumatology, Seihoku Central Hospital, Goshogawara, Aomori, Japan
⁸Nishimaki Clinic, Sukagawa, Fukushima, Japan
⁹Fukushima Daiichi Hospital, Fukushima, Fukushima, Japan
¹⁰Akita University Graduate School of Medicine, Akita, Akita, Japan
¹¹Morioka National Hospital, Morioka, Iwate, Japan
¹²Department of Internal Medicine and Gastroenterology, Japanese Red Cross Fukushima Hospital, Fukushima, Fukushima, Japan
¹³Department of Orthopaedic surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
¹⁴Ishinomaki Loyal Hospital, Ishinomaki, Miyagi, Japan
¹⁵Ohta Nishinouchi Hospital, Koriyama, Fukushima, Japan
¹⁶Hikarigaoka Spellman Hospital, Sendai, Miyagi, Japan
¹⁷Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Yamagata, Japan
¹⁸Ninomiya Medical Clinic, Morioka, Iwate, Japan
¹⁹Yamagata Prefectural Shinjo Hospital, Shinjo, Yamagata, Japan
²⁰Kuroishi General Hospital, Aomori, Aomori, Japan
²¹Saito Clinic, Aizuwakamatsu, Fukushima, Japan
²²NTT East Japan Tohoku Hospital, Sendai, Miyagi, Japan

Hepatitis B virus (HBV) reactivation has been increasingly recognized in patients receiving chemotherapy and immunosuppressive therapy; however, the prevalence of HBV infection and rate of HBV screening in patients with rheumatic diseases remains unclear. In this study, we aimed to assess the prevalence of HBV infection and fulminant HBV hepatitis in patients with rheumatic diseases. We also investigated the rate of HBV screening before immunosuppressive therapy in patients with rheumatic diseases. A retrospective questionnaire survey was conducted in the North-east area (Tohoku) of Japan. Questionnaires, comprising 6 questions, were sent to 318 rheumatologists in May 2010, and responses were gathered until June 2011. In total, 71 rheumatologists (22.3%) responded to the survey. We enrolled 7,650 patients with rheumatoid arthritis (RA) and 1,031 patients with systemic lupus erythematosus (SLE). When limited to institutes at which almost all (≥ 90%) patients were tested for HBV serology, 1.1% (40/3,580) patients with RA and 0.3% (3/1,128) patients with SLE were positive for hepatitis B surface antigen (HBsAg), and 25.2% (177/703) patients with RA and 13.7% (34/248) patients with SLE were positive for hepatitis B core antibody (HBcAb). About one-third of rheumatologists did not check HBsAg and more than half did not check hepatitis B surface antibody (HBsAb) or HBcAb at all before therapy. Fulminant HBV hepatitis was observed in 1 RA patient who was current HBV carrier. In conclusion, the prevalence of HBV infection is high in patients with RA and SLE. HBV screening before immunosuppressive therapy should be strictly performed.

keywords —— hepatitis B virus; immunosuppressive therapy; rheumatoid arthritis; screening; systemic lupus erythematosus

© 2014 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2014, 233, 129-133

Correspondence: Tomonori Ishii, M.D., Ph.D., Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

e-mail: tishii@med.tohoku.ac.jp