Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Hepatitis testing is an important pre-requisite to the diagnosis and treatment of patients with rheumatic disease. Joint symptoms may be a manifestation of acute or chronic hepatitis B or C. Immunosuppressive treatment may increase viral load in patients with undiagnosed viral hepatitis. The prevalence of hepatitis varies amongst populations, but even in areas with low endemic levels, it is imperative to identify those in whom current or past infection may influence clinical outcome. The CDC recommends testing for 4 components: hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B core antibody and hepatitis C antibody. Although ACR recommendations do not specifically recommend hepatitis screening, they do advocate vaccination against hepatitis B in all patients. This study was conducted in order to identify new cases of hepatitis in a cohort of patients with RA attending a large university teaching hospital and to evaluate the extent of the hepatitis screen undertaken.
Methods:
One hundred consecutive patients, with a diagnosis of RA, were retrospectively assessed for completeness of hepatitis screening by reviewing their hospital records. A dedicated teaching session for all members of the rheumatology team was then conducted, highlighting the results of the survey and explaining the rationale for complete hepatitis screening in all patients with RA. Paper reminders were placed on all desks to alert staff to screen patients at clinic review. A prospective study of hepatitis screening of a separate cohort 100 consecutive out-patients with RA was then performed.
Results:
In the initial 100 patients, 21% were male, mean age was 65 years. 85% were taking methotrexate and 22% were on biologic treatments (18% anti-TNF agent, 4% Rituximab). Liver profile was abnormal in 20%. A complete hepatitis screen was present in only 8%, while 12% had a hepatitis B core antibody checked and 53% had a test for hepatitis C.
In the 100 patients assessed after staff education, 26% were male, mean age was 63 years. 86% were taking methotrexate and 27% were on biologic treatments (23% anti-TNF agent, 4% Rituximab). Liver profile was abnormal in 30%. A full hepatitis screen was available in 63%, while 65% had a hepatitis B core antibody checked and 81% had a test for hepatitis C.
In the total 200 patients, we identified 3 cases of positive hep B core antibody, 11 cases of positive hep B surface antibody and 1 case of positive hep C antibody. On retrospective analysis, 2 had identifiable risk factors for blood-borne infections (both healthcare workers).
Table 1: Completeness of Hepatitis Screening
|
|
Pre education, n=100 |
Post education, n=100 |
|
Any hepatitis screen |
54% |
81% |
|
Full hepatitis screen |
8% |
63% |
|
Hep B surface antigen |
40% |
77% |
|
Hep B surface antibody |
46% |
77% |
|
Hep B core antibody |
12% |
65% |
|
Hep C antibody |
53% |
81% |
Conclusion:
Even in populations where hepatitis B or C is not endemic, laboratory screening will reveal new cases of hepatitis that should be identified prior to immunosuppressive treatment. Educational initiatives are helpful in teaching staff working in busy clinical environments to screen patients, but ongoing reminders are likely to be essential.
Disclosure:
R. Conway,
Roche Pharmaceuticals,
2,
UCB Pharma,
2,
Merck Pharmaceuticals,
7;
M. Doran,
None;
F. D. O’Shea,
None;
G. Cunnane,
None.
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