title: The impact of hepatitis screening on diagnosis and treatment in rheumatoid arthritis.
abstract: Identification of patients with exposure to viral hepatitis is an important part of the care of patients with inflammatory arthritis. This study was conducted to assess the extent of hepatitis B and C screening, and the prevalence of viral hepatitis in a cohort of patients with established rheumatoid arthritis (RA). The medical records of 100 consecutive RA patients were retrospectively analysed for screening of hepatitis B surface antigen, surface antibody and core antibody and hepatitis C antibody. A teaching session was then conducted with the rheumatology team, emphasising the rationale for viral hepatitis testing. We then prospectively analysed 100 more RA patients to see if hepatitis screening improved. In the initial 100 patients (21 % male, mean age 65 years), 85 % were taking methotrexate and 22 % biologic treatments. A complete hepatitis screen was present in 8 %, while 12 % had hepatitis B core antibody checked and 53 % had been tested for hepatitis C.The second cohort of patients was similar to the first in terms of demographics and treatment. A complete hepatitis screen was available in 63 %, while 65 % had hepatitis B core antibody checked and 81 % had been tested for hepatitis C.In total, we identified 4 new cases of positive hepatitis B core antibody, 11 cases of positive hepatitis B surface antibody and 1 case of positive hepatitis C antibody. Even in populations where hepatitis B or C is non-endemic, screening will reveal new cases. Educational initiatives are helpful in teaching staff to screen patients.
authors.affiliation: Department of Rheumatology, St. James Hospital, Dublin, Ireland, drrichardconway@gmail.com.
authors.forename: Richard
authors.initials: R
authors.lastname: Conway
authors.forename: Michele F
authors.initials: MF
authors.lastname: Doran
authors.forename: Finbar D
authors.initials: FD
authors.lastname: O'Shea
authors.forename: Brendan
authors.initials: B
authors.lastname: Crowley
authors.forename: Gaye
authors.initials: G
authors.lastname: Cunnane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis* / Q000821:virology; D015331:Cohort Studies; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000737:chemistry; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D007166:Immunosuppressive Agents; D008727:Methotrexate
references.citation: Epidemiol Infect. 2009 Jul;137(7):961-9
references.pmid: 19102797
references.citation: Ann Rheum Dis. 2011 Oct;70(10):1719-25
references.pmid: 21719446
references.citation: MMWR Recomm Rep. 2008 Sep 19;57(RR-8):1-20
references.pmid: 18802412
references.citation: Ann Rheum Dis. 2010 Jul;69(7):1352-5
references.pmid: 20472596
references.citation: Mod Rheumatol. 2011 Feb;21(1):16-23
references.pmid: 20668905
references.citation: Ann Rheum Dis. 2006 Aug;65(8):983-9
references.pmid: 16627542
references.citation: Arthritis Rheum. 1988 Mar;31(3):315-24
references.pmid: 3358796
references.citation: Ann Rheum Dis. 2011 Oct;70(10):1701-3
references.pmid: 21893581
references.citation: Arthritis Care Res (Hoboken). 2012 May;64(5):625-39
references.pmid: 22473917
references.citation: Epidemiol Infect. 1999 Feb;122(1):133-8
references.pmid: 10098796
references.citation: J Hepatol. 2007 Jan;46(1):160-70
references.pmid: 17112622
references.citation: J Infect. 2002 Nov;45(4):219-26
references.pmid: 12423608
references.citation: Epidemiol Infect. 2012 Aug;140(8):1461-8
references.pmid: 21923968