title: [How does one manage patients with rheumatoid arthritis and positive serology to hepatitis B, hepatitis C, human immunodeficiency virus?].
abstract: Chronic viral infections in rheumatic patients are a diagnostic and therapeutic challenge. Some of the disease-modifying antirheumatic drugs (DMARD) commonly used in rheumatoid arthritis, such as methotrexate and leflunomide, are hepatotoxic. With biological therapy, which is now widely used in patients refractory to these and other DMARD, some cases of reactivation of hepatitis B, even fulminant cases, have been reported, especially when employing TNF antagonists and rituximab, so their use must be carefully assessed and usually accompanied by antiviral therapy. However, there have not been reports of reactivation of hepatitis C after immunosuppressive therapy. In patients with HIV infection, administration of immunosuppressive therapy carries a high risk of opportunistic infections, although the new highly active antiviral therapy allows the use of some drugs in selected cases.
authors.affiliation: Servicio de Reumatología, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, España. srcabrer@clinic.ub.es
authors.forename: Sonia Raquel
authors.initials: SR
authors.lastname: Cabrera Villalba
authors.forename: María
authors.initials: M
authors.lastname: Victoria Hernández Miguel
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmartí Sala
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D056486:Chemical and Drug Induced Liver Injury; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000276:immunology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007555:Isoxazoles / Q000009:adverse effects / Q000627:therapeutic use; D000077339:Leflunomide; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D000069283:Rituximab; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D007555:Isoxazoles; D014409:Tumor Necrosis Factor-alpha; D000069283:Rituximab; D000077339:Leflunomide; D008727:Methotrexate