Multidisciplinary Approach to Prevent de novo Hepatitis B in Patients with Rheumatoid Arthritis

Multidisciplinary Approach to Prevent de novo Hepatitis B in Patients with Rheumatoid Arthritis

RYU WATANABE,^1,2 TAKEHIKO IGARASHI,³ TARO TAKAHASHI,⁴ HINAKO KONDO,^1,5 SOSHI OKAZAKI,^1,2 MASATAKA KUDO,^1,5 MASAKAZU OHYANAGI⁶ and MAKIO GAMOH⁷

¹Department of Rheumatology, Osaki Citizen Hospital, Osaki, Miyagi, Japan
²Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
³Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Miyagi, Japan
⁴Department of Hematology, Osaki Citizen Hospital, Osaki, Miyagi, Japan
⁵Department of Nephrology and Endocrinology, Osaki Citizen Hospital, Osaki, Miyagi, Japan
⁶Department of Clinical Laboratory, Osaki Citizen Hospital, Osaki, Miyagi, Japan
⁷Department of Medical Oncology, Osaki Citizen Hospital, Osaki, Miyagi, Japan

The reactivation of hepatitis B virus (HBV) in patients with rheumatoid arthritis (RA) is currently a social problem. Our hospital has established a project team, which consisted of medical staff including doctors, nurses, pharmacists, and technicians, to prevent HBV reactivation and subsequent de novo hepatitis B in 2015. To verify the usefulness of the team, we aimed to examine the implementation rate of HBV screening tests in patients with RA in 2011, 2015, and 2018. We also examined the rate of HBV infection, as well as the rate of HBV reactivation during the course. In this study, medical records of patients who visited our hospital in 2011, 2015, and 2018 were retrospectively reviewed. HBV screening was completed when hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and hepatitis B core antibody (HBcAb) were all examined. The prevalence of patients who completed HBV screening dramatically increased from 2.4% in 2011 to 79.1% in 2015 and 86.9% in 2018. Patients who completed the screening had significantly higher rates of liver dysfunction, methotrexate use, and use of biological disease-modifying antirheumatic drugs than those who did not. Of the 767 patients who completed HBV screening in 2018, 157 patients (20.5%) had previously resolved HBV infection (HBsAg-negative but HBsAb- and/or HBcAb-positive). During a mean follow-up of 41.0 months, reactivation of HBV was observed in 10 out of the 157 patients (6.4%); however, none developed de novo hepatitis B. In conclusion, our multidisciplinary approach to prevent de novo hepatitis B is considered useful.

Keywords —— hepatitis B virus; previously resolved infection; reactivation; rheumatoid arthritis; screening

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Tohoku J. Exp. Med., 2020 , 252, 133-141.

Correspondence: Ryu Watanabe, M.D., Ph.D., Department of Rheumatology, Osaki Citizen Hospital, 3-8-1 Furukawa Honami, Osaki, Miyagi 989-6183, Japan.

e-mail: doctorwatanaberyu@yahoo.co.jp

*Deceased January, 2020.