Clinical support by hepatologist in rheumatoid arthritis management

Abstract

    I would like to mention the latest management of liver disease with hepatitis virus in patients with rheumatoid arthritis (RA). First, RA patients are frequently referred to a hepatologist to consult on drug induced liver damage. One of the most important etiologies in such patients was hepatitis B virus (HBV) reactivation. HBV reactivation is well known that HBV viral load increase more than one log copies/mL in patients under immunosuppressive or cytotoxic therapy who are both HBsAg-positive and HBsAg-negative/anti-HBc-positive. HBV reactivation followed to hepatitis flare is frequently fetal outcome. The guideline recommends that HBV DNA monitoring is necessary for patients with HBV carrier and with past HBV infection who start immunosuppressive therapy for RA. In case of HBV reactivation, immediate administration of nucleotide analogue can prevent HBV reactivation related to hepatitis. Next, I address the management of hepatitis C virus (HCV). It is not necessary for RA patients to monitor HCV RNA, because exacerbation of chronic hepatitis C rarely occurs under treatment for RA. On the other hand, previous interferon therapy for HCV worsens symptom and clinical data of RA patients. Recently, interferon-free direct antiviral agents (DAA) have been approved for patients with HCV. DAA regimens are more effective and safer. It is possible for RA patients with HCV to start DAA therapy.