Date: Monday, November 6, 2017
Session 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.
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 November 20, 2018.
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