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Viral Hepatitis: Review of Arthritic Complications and Therapy for Arthritis in the Presence of Active HBV/HCV

  • INFECTIONS AND ARTHRITIS (K WINTHROP, SECTION EDITOR)
  • Published:
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Abstract

Chronic infection with hepatitis B (HBV) or C (HCV) virus, which currently affect approximately 7 % of the world population, is encountered with the same frequency among patients with arthritis starting biological or non-biological disease-modifying anti-rheumatic drugs (DMARDs). Treatment with biological agents, including anti-tumor necrosis factor agents, rituximab, and abatacept, without appropriate antiviral therapy has been associated with reactivation of HBV infection which in some cases can lead to life-threatening complications, indicating the need for appropriate screening and treatment of these patients. In this review, the latest data regarding HBV or HCV-related arthritic complications and treatment of rheumatic diseases in the presence of chronic HBV or HCV infection will be critically presented.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Vassilopoulos D, Calabrese LH. Management of rheumatic disease with comorbid HBV or HCV infection. Nat Rev Rheumatol. 2012;8:348–57.

    Article  PubMed  CAS  Google Scholar 

  2. Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008;359:1486–500.

    Article  PubMed  CAS  Google Scholar 

  3. Lok ASF, McMahon BJ. AASLD practice guidelines. Chronic Hepatitis B: Update 2009. Accessed at www.aasld.org. Accessed 18 Dec 2012.

  4. Vassilopoulos D, Manolakopoulos S. Rheumatic manifestations of hepatitis. Curr Opin Rheumatol. 2010;22:91–6.

    Article  PubMed  CAS  Google Scholar 

  5. Varache S, Narbonne V, Jousse-Joulin S, et al. Is routine viral screening useful in patients with recent-onset polyarthritis of a duration of at least 6 weeks? Results from a nationwide longitudinal prospective cohort study. Arthritis Care Res (Hoboken). 2011;63:1565–70.

    Article  Google Scholar 

  6. Tan J, Zhou J, Zhao P, et al. Prospective study of HBV reactivation risk in rheumatoid arthritis patients who received conventional disease-modifying antirheumatic drugs. Clin Rheumatol. 2012;31:1169–75.

    Article  PubMed  Google Scholar 

  7. Hoofnagle JH. Reactivation of hepatitis B. Hepatology. 2009;49:S156–65.

    Article  PubMed  CAS  Google Scholar 

  8. • Perez-Alvarez R, Diaz-Lagares C, Garcia-Hernandez F, et al. Hepatitis B Virus (HBV) Reactivation in Patients Receiving Tumor Necrosis Factor (TNF)-Targeted Therapy: Analysis of 257 Cases. Medicine (Baltimore). 2011;90:359–71. A comprehensive literature review of all cases of chronic or past HBV infection treated with anti-TNF agents.

    Article  CAS  Google Scholar 

  9. •• Vassilopoulos D, Apostolopoulou A, Hadziyannis E, et al. Long-term safety of anti-TNF treatment in patients with rheumatic diseases and chronic or resolved hepatitis B virus infection. Ann Rheum Dis. 2010;69:1352–5. Prospective study of 14 patients with chronic HBV infection treated with prophylactic antiviral therapy and anti-TNF agents and of 19 cases of past HBV infection treated with anti-TNFs alone.

    Article  PubMed  CAS  Google Scholar 

  10. Evens AM, Jovanovic BD, Su YC, et al. Rituximab-associated hepatitis B virus (HBV) reactivation in lymphoproliferative diseases: meta-analysis and examination of FDA safety reports. Ann Oncol. 2011;22:1170–80.

    Article  PubMed  CAS  Google Scholar 

  11. Mendez-Navarro J, Corey KE, Zheng H, et al. Hepatitis B screening, prophylaxis and re-activation in the era of rituximab-based chemotherapy. Liver Int. 2011;31:330–9.

    Article  PubMed  Google Scholar 

  12. Chen XQ, Peng JW, Lin GN, et al. The effect of prophylactic lamivudine on hepatitis B virus reactivation in HBsAg − positive patients with diffuse large B-cell lymphoma undergoing prolonged rituximab therapy. Med Oncol. 2012;29:1237–41.

    Google Scholar 

  13. Pyrpasopoulou A, Douma S, Vassiliadis T, et al. Reactivation of chronic hepatitis B virus infection following rituximab administration for rheumatoid arthritis. Rheumatol Int. 2011;31:403–4.

    Article  PubMed  Google Scholar 

  14. Mitroulis I, Hatzara C, Kandili A, et al. Long-term safety of rituximab in patients with rheumatic diseases and chronic or resolved hepatitis B virus infection. Ann Rheum Dis. 2013;72:308–10.

    Google Scholar 

  15. Kim PS, Ho GY, Prete PE, et al. Safety and efficacy of abatacept in eight rheumatoid arthritis patients with chronic hepatitis B. Arthritis Care Res (Hoboken ). 2012;64:1265–8.

    CAS  Google Scholar 

  16. Said ZN. An overview of occult hepatitis B virus infection. World J Gastroenterol. 2011;17:1927–38.

    Article  PubMed  Google Scholar 

  17. Abramson A, Menter A, Perrillo R. Psoriasis, hepatitis B, and the tumor necrosis factor-alpha inhibitory agents: A review and recommendations for management. J Am Acad Dermatol. 2012;67:1349–61.

    Article  PubMed  CAS  Google Scholar 

  18. Ioannou GN. Hepatitis B virus in the United States: infection, exposure, and immunity rates in a nationally representative survey. Ann Intern Med. 2011;154:319–28.

    PubMed  Google Scholar 

  19. Giardina AR, Ferraro D, Ciccia F, et al. No detection of occult HBV-DNA in patients with various rheumatic diseases treated with anti-TNF agents: a two-year prospective study. Clin Exp Rheumatol 2012. 2013;31:25–30.

    Google Scholar 

  20. Urata Y, Uesato R, Tanaka D, et al. Prevalence of reactivation of hepatitis B virus replication in rheumatoid arthritis patients. Mod Rheumatol. 2011;21:16–23.

    Article  PubMed  CAS  Google Scholar 

  21. Mori S. Past hepatitis B virus infection in rheumatoid arthritis patients receiving biological and/or nonbiological disease-modifying antirheumatic drugs. Mod Rheumatol. 2011;21:621–7.

    Article  PubMed  CAS  Google Scholar 

  22. Lee YH, Bae SC, Song GG. Hepatitis B virus (HBV) reactivation in rheumatic patients with hepatitis core antigen (HBV occult carriers) undergoing anti-tumor necrosis factor therapy. Clin Exp Rheumatol. 2013;31:118–21.

    Google Scholar 

  23. EASL clinical practice guidelines: management of chronic hepatitis B virus infection. J Hepatol. 2012;57:167–185.

    Google Scholar 

  24. Lok AS, Ward JW, Perrillo RP, et al. Reactivation of hepatitis B during immunosuppressive therapy: potentially fatal yet preventable. Ann Intern Med. 2012;156:743–5.

    PubMed  Google Scholar 

  25. Stine JG, Khokhar OS, Charalambopoulos J, et al. Rheumatologists’ awareness of and screening practices for hepatitis B virus infection prior to initiating immunomodulatory therapy. Arthritis Care Res (Hoboken ). 2010;62:704–11.

    Article  Google Scholar 

  26. Vaughn BP, Doherty GA, Gautam S, et al. Screening for tuberculosis and hepatitis B prior to the initiation of anti-tumor necrosis therapy. Inflamm Bowel Dis. 2012;18:1057–63.

    Article  PubMed  Google Scholar 

  27. Ghany MG, Strader DB, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49:1335–74.

    Article  PubMed  CAS  Google Scholar 

  28. Smith BD, Morgan RL, Beckett GA, et al. Hepatitis C virus testing of persons born during 1945 to 1965: recommendations from the Centers for Disease Control and Prevention. Ann Intern Med. 2012;157:817–22.

    Google Scholar 

  29. Vassilopoulos D, Calabrese LH. Rheumatic manifestations of hepatitis C infection. Curr Rheumatol Rep. 2003;5:200–4.

    Article  PubMed  Google Scholar 

  30. Rosner I, Rozenbaum M, Toubi E, et al. The case for hepatitis C arthritis. Semin Arthritis Rheum. 2004;33:375–87.

    Article  PubMed  Google Scholar 

  31. Ogdie A, Schumacher Jr HR, Dai L, et al. Synovial biopsy findings in arthritis associated with hepatitis C virus infection. J Rheumatol. 2010;37:1361–3.

    Article  PubMed  Google Scholar 

  32. Zuckerman E, Keren D, Rozenbaum M, et al. Hepatitis C virus-related arthritis: characteristics and response to therapy with interferon alpha. Clin Exp Rheumatol. 2000;18:579–84.

    Article  PubMed  CAS  Google Scholar 

  33. Ramos-Casals M, Stone JH, Cid MC, et al. The cryoglobulinaemias. Lancet. 2012;379:348–60.

    Article  PubMed  CAS  Google Scholar 

  34. Ferri C, Sebastiani M, Giuggioli D, et al. Mixed cryoglobulinemia: demographic, clinical, and serologic features and survival in 231 patients. Semin Arthritis Rheum. 2004;33:355–74.

    Article  PubMed  Google Scholar 

  35. Saadoun D, Asselah T, Resche-Rigon M, et al. Cryoglobulinemia is associated with steatosis and fibrosis in chronic hepatitis C. Hepatology. 2006;43:1337–45.

    Article  PubMed  CAS  Google Scholar 

  36. Kayali Z, Buckwold VE, Zimmerman B, et al. Hepatitis C, cryoglobulinemia, and cirrhosis: a meta-analysis. Hepatology. 2002;36:978–85.

    PubMed  Google Scholar 

  37. Terrier B, Semoun O, Saadoun D, et al. Prognostic factors in patients with hepatitis C virus infection and systemic vasculitis. Arthritis Rheum. 2011;63:1748–57.

    Article  PubMed  Google Scholar 

  38. Mazzaro C, Zorat F, Caizzi M, et al. Treatment with peg-interferon alfa-2b and ribavirin of hepatitis C virus-associated mixed cryoglobulinemia: a pilot study. J Hepatol. 2005;42:632–8.

    Article  PubMed  CAS  Google Scholar 

  39. Joshi S, Kuczynski M, Heathcote EJ. Symptomatic and virological response to antiviral therapy in hepatitis C associated with extrahepatic complications of cryoglobulimia. Dig Dis Sci. 2007;52:2410–7.

    Article  PubMed  CAS  Google Scholar 

  40. Saadoun D, Resche RM, Sene D, et al. Rituximab plus Peg-interferon-alpha/ribavirin compared with Peg-interferon-alpha/ribavirin in hepatitis C-related mixed cryoglobulinemia. Blood. 2010;116:326–34.

    Article  PubMed  CAS  Google Scholar 

  41. Dammacco F, Tucci FA, Lauletta G, et al. Pegylated interferon-alpha, ribavirin, and rituximab combined therapy of hepatitis C virus-related mixed cryoglobulinemia: a long-term study. Blood. 2010;116:343–53.

    Article  PubMed  CAS  Google Scholar 

  42. Clinical EASL. Practice Guidelines: management of hepatitis C virus infection. J Hepatol. 2011;55:245–64.

    Article  Google Scholar 

  43. Vassilopoulos D, Calabrese LH. Hepatitis C virus infection and vasculitis. Implications of antiviral and immunosuppressive therapies. Arthritis Rheum. 2002;46:585–97.

    Article  PubMed  Google Scholar 

  44. Ghany MG, Nelson DR, Strader DB, et al. An update on treatment of genotype 1 chronic hepatitis C virus infection: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology. 2011;54:1433–44.

    Article  PubMed  Google Scholar 

  45. Lok AS, Gardiner DF, Lawitz E, et al. Preliminary study of two antiviral agents for hepatitis C genotype 1. N Engl J Med. 2012;366:216–24.

    Article  PubMed  CAS  Google Scholar 

  46. •• De Vita S, Quartuccio L, Isola M, et al. A randomized controlled trial of rituximab for the treatment of severe cryoglobulinemic vasculitis. Arthritis Rheum. 2012;64:843–53. A randomized controlled trial comparing conventional immunosuppressive therapy with rituximab for patients who had failed, did not tolerate, or had contraindications to antiviral therapy.

    Article  PubMed  Google Scholar 

  47. •• Sneller MC, Hu Z, Langford CA. A randomized controlled trial of rituximab following failure of antiviral therapy for hepatitis C virus-associated cryoglobulinemic vasculitis. Arthritis Rheum. 2012;64:835–42. An open-label, randomized controlled trial comparing conventional immunosuppressive therapy with rituximab for patients who had failed or did not tolerate antiviral treatment.

    Article  PubMed  CAS  Google Scholar 

  48. Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59:762–84.

    Article  PubMed  CAS  Google Scholar 

  49. Furst DE, Keystone EC, Braun J, et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2011. Ann Rheum Dis. 2012;71 Suppl 2:i2–45.

    Article  PubMed  CAS  Google Scholar 

  50. Brunasso AM, Puntoni M, Gulia A, et al. Safety of anti-tumour necrosis factor agents in patients with chronic hepatitis C infection: a systematic review. Rheumatology (Oxford). 2011;50:1700–11.

    Article  CAS  Google Scholar 

  51. Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64:625–39.

    Article  CAS  Google Scholar 

  52. Terrier B, Saadoun D, Sene D, et al. Efficacy and tolerability of rituximab with or without PEGylated interferon alfa-2b plus ribavirin in severe hepatitis C virus-related vasculitis: a long-term followup study of thirty-two patients. Arthritis Rheum. 2009;60:2531–40.

    Article  PubMed  CAS  Google Scholar 

  53. Petrarca A, Rigacci L, Caini P, et al. Safety and efficacy of rituximab in patients with hepatitis C virus-related mixed cryoglobulinemia and severe liver disease. Blood. 2010;116:335–42.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Dr Vassilopoulos’ work was supported in part by research grants from the Hellenic Society for Rheumatology and the Special Account for Research Grants (S.A.R.G.), National and Kapodistrian University of Athens, Athens, Greece.

Conflict of Interest

Dr Vassilopoulos has received honoraria from: Pfizer; Merck, Sharp and Dohme; UCB; Actelion Pharmaceuticals; and Roche.

Dr Calabrese has served as a consultant for Genentech, Roche, Pfizer, Sanofi-Aventis, and Bristol-Myers Squibb and has received honoraria from Genentech, Roche, Pfizer, Bristol–Myers Squibb, and Janssen Pharmaceutica.

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Authors and Affiliations

  1. 2nd Department of Medicine, Hippokration General Hospital, Athens University School of Medicine, 114 Vass. Sophias Ave, 115 27, Athens, Greece

    Dimitrios Vassilopoulos

  2. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, 9500 Euclid Avenue, Desk A50, Cleveland, OH, 44195, USA

    Leonard H. Calabrese

Authors
  1. Dimitrios Vassilopoulos
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  2. Leonard H. Calabrese
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Correspondence to Dimitrios Vassilopoulos.

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This article is part of the Topical Collection on Infections and Arthritis

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Vassilopoulos, D., Calabrese, L.H. Viral Hepatitis: Review of Arthritic Complications and Therapy for Arthritis in the Presence of Active HBV/HCV. Curr Rheumatol Rep 15, 319 (2013). https://doi.org/10.1007/s11926-013-0319-1

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  • DOI: https://doi.org/10.1007/s11926-013-0319-1

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