ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1099

Hepatitis B Reactivation in Rheumatologic Patients

Yassir Daghistani1, Fergus To2, Patrick Doyle3,4, Hin Hin Ko5, Mel Krajden3,4, Jason Kur2, Alnoor Ramji6, Kam Shojania2, Edward Tam5, John Wade2, Eric Yoshida5, Graham Reid2, Siegfried Erb5 and Mollie Carruthers2, 1Medicine, University of British Columbia, Vancouver, BC, Canada, 2Rheumatology, University of British Columbia, Vancouver, BC, Canada, 3Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada, 4BC Centre for Disease Control, Vancouver, BC, Canada, 5Gastroenterology, University of British Columbia, Vancouver, BC, Canada, 6Gatroenterology, University of British Columbia, Vancouver, BC, Canada

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: , , ,

Session Information

Date: Monday, November 6, 2017

Title: Measures and Measurement of Healthcare Quality Poster I

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: The widespread usage of biologic disease modifying anti-rheumatic drugs (bDMARDs) in rheumatology has increased the risk of hepatitis B virus (HBV) re-activation. The prevalence of chronic HBV infection was estimated at 3.0% and 3.5%, respectively in two large, cross-sectional studies in rheumatoid arthritis and spondyloarthropathies internationally. HBV reactivation (HBVr) after using immunosuppressive medicines has been observed in 6.8% of fulminant hepatitis cases in Japan. We aimed to quantify the knowledge gap in the practice of rheumatologists with regards to management of HBVr in rheumatologic patients using a Canada-wide survey.

Methods: In order to assess the discrepancy in practice with regards to dealing with HBV infection in patients started on biologic and non-biologic DMARDs, we conducted a short pilot survey of 15 rheumatologists and 2 rheumatology fellows at an inter-city rheumatology rounds aimed at assessing any knowledge gap. Subsequently, an expert panel of five hepatologists, two infectious disease specialists and four rheumatologists helped generate a final questionnaire. The final survey included questions regarding chronic hepatitis B monitoring and anti-viral prophylaxis with either biologic or non-biologic DMARDs or corticosteroids. A Canada-wide survey was sent to the Canadian Rheumatology Association (CRA) members. The results were compared to the American Gastroenterology Association (AGA) guidelines.

Results: There were 17 respondents to the pilot survey. Of 7 questions in the pilot survey, there were 47% of questions that were either answered incorrectly or marked “I don’t know”. The final survey was sent to 521 members of CRA. The response rate was 27.25% for a total of 142 responses. Interestingly, 8.8% of the responders thought not to send their HBsAg positive patients to a gastroenterologist, although anti-viral prophylaxis would be indicated and hepatology monitoring. There were 58% of the respondents who would order unnecessary test like anti-HBs for monitoring a patient who is HBsAg positive and is on immunosuppressive medication. Another 43% answered incorrectly to start anti-viral prophylaxis for patients who are HBsAg positive and are on DMARDs.

Conclusion: The results of our survey highlight the knowledge gap in monitoring and treating chronic hepatitis B in rheumatology patients. All patients with hepatitis B surface antigen positivity on immunosuppression including prednisone should be referred to gastroenterology. Similarly, patients on high risk medicines with hepatitis B core antibody positivity despite hepatitis surface antibody status should be monitored and started early on anti-viral prophylaxis.

Disclosure: Y. Daghistani, None; F. To, None; P. Doyle, None; H. H. Ko, None; M. Krajden, None; J. Kur, None; A. Ramji, None; K. Shojania, None; E. Tam, None; J. Wade, None; E. Yoshida, None; G. Reid, None; S. Erb, None; M. Carruthers, None.

To cite this abstract in AMA style:

Daghistani Y, To F, Doyle P, Ko HH, Krajden M, Kur J, Ramji A, Shojania K, Tam E, Wade J, Yoshida E, Reid G, Erb S, Carruthers M. Hepatitis B Reactivation in Rheumatologic Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/hepatitis-b-reactivation-in-rheumatologic-patients/. Accessed .

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