title: Hepatitis B Serology in Patients with Rheumatic Diseases.
abstract: BACKGROUND
  Only limited data are available on the prevalence of hepatitis B in patients with proven rheumatic diseases and thus the risk of reactivation under immunosuppressive therapy.
  
  
  OBJECTIVE
  To analyse hepatitis B serology in patients with rheumatic diseases prior to therapy.
  
  
  METHODS
  In total, 1,338 patient records were analysed for HBsAg, HBsAb and HBcAb in a cross-sectional, single-centre study between 2011 and 2015 at first presentation. Data acquisition was realized using electronic patient files created during routine care. The main variables considered as predictors for HBV reactivation included (i) the exact type of rheumatic disease and (ii) the therapeutically induced immunosuppression.
  
  
  RESULTS
  Overall, 5.9% of patients (n=79) had proven contact with hepatitis B (HBcAb positive), and HBsAb were not detected in 1.3% (n=18). The rate of vaccinated subjects was 7.8%. HBsAg was detected in 3 patients (0.2%). In addition, 70.3% of patients were treated during the course of rheumatologic disease previously or currently with glucocorticoids, 85.2% with disease-modifying anti-rheumatic drugs (DMARDs) and 20.1% with a biologic agent (e.g., anti-IL-6, anti-TNFalpha, anti-CD20, CTLA4Ig or anti-IL-12/23).
  
  
  CONCLUSIONS
  Prevalence of hepatitis B serostatus in the analysed rheumatic patients regarding HBs-Ag and HBcAb with or without HBsAb prior to therapy does not differ from the data published for the general population in Germany. However, the rate of hepatitis B vaccinated patients was lower. In general, a significant portion of patients (5.9%) has been exposed to HBV and therefore exhibited an increased risk of reactivation of hepatitis B when undergoing immunosuppressive therapy.
authors.affiliation: University of Wuerzburg - Medizinische Klinik und Poliklinik II Würzburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Feuchtenberger
authors.affiliation: University of Wuerzburg - Medizinische Klinik und Poliklinik II Würzburg, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Schäfer
authors.affiliation: University of Wuerzburg - Medizinische Klinik und Poliklinik II Würzburg, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Philipp Nigg
authors.affiliation: University of Wuerzburg - Medizinische Klinik und Poliklinik II Würzburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Rupert Kraus
keywords: HBV; HBcAb; HBsAb; HBsAg; Hepatitis B; Immunosuppression; Reactivation; Rheumatic disease