Background/Purpose:   The risk of infection in patients with RA is higher than in comparable patients but still the vaccination rates in RA patients are low.  The recent 2015 American College of Rheumatology guidelines for the treatment of rheumatoid arthritis strongly recommended serologic testing and vaccination for hepatitis B before and during anti-TNF therapy.

Methods:   Patients who were getting anti-TNF therapy at the VA Connecticut Healthcare System Newington campus were identified from review of pharmacy records. 52 patients were identified after reviewing the charts of which 25 patients met the 2010 American College of Rheumatology classification criteria for RA and were included in this study. 27 patients taking anti-TNF therapy but who did not have RA were excluded (psoriatic arthritis, psoriasis, seronegative spondyloarthropathy etc). Hepatitis B serology was reviewed using the electronic medical record lab data base.

Results:   18 patients came to the VA for medication after being started on anti-TNF therapy by their private rheumatologists while remaining 7 were started at the VA. Only 2 (8%) patients had accurate hepatitis B serology, 7 (28%) had incomplete serology namely Hepatitis B Core ab was missing (4 were co-managed by private MD) and 16 (64%) patients had no Hepatitis B serology (14 were co-managed by private MD). The 23 identified patients lacking appropriate hepatitis B serology testing were contacted and the need for hepatitis B serology and vaccination was discussed. After further lab testing – 3 patients were found to be immune for hepatitis B, 2 patients had isolated anti-HBc status who on further testing had negative PCR for Hepatitis B viral load (i.e. resolved HBV infection) & 1 patient was lost to follow up. The remaining 19 patients underwent start of successful vaccination schedule for Hepatitis B.

Conclusion:    

1. In our study sample we found very poor and incomplete compliance (92%) to hepatitis B screening in RA patients receiving anti-TNF therapy & majority of them (72%) were being co-managed by private rheumatologist.
2. We were able to successfully vaccinate the RA patients against Hepatitis B.
3. This study has also brought to our attention the need to address the critical knowledge gap for the need to check Hepatitis B core ab levels. Incomplete screening can lead to dangerous complications of reactivation of Hepatitis B. We found 2 patients with resolved HBV infection who needed close monitoring to prevent reactivation of Hepatitis B while on therapy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/monitoring-hepatitis-b-screening-compliance-in-patients-with-rheumatoid-arthritis-ra-receiving-anti-tnf-therapy/