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World J Clin Cases. Jan 7, 2022; 10(1): 12-22
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.12
Hepatitis B virus reactivation in rheumatoid arthritis
Ya-Li Wu, Jing Ke, Bao-Yu Zhang, Dong Zhao
Ya-Li Wu, Jing Ke, Bao-Yu Zhang, Dong Zhao, Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
Author contributions: Wu YL drafted the article; Ke J, Zhang BY, and Zhao D critically revised and prepared the manuscript; all authors read and approved the submitted version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no actual or potential competing interest related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Zhao, MD, PhD, Associate Professor, Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing 101149, China. zhaodong@ccmu.edu.cn
Received: June 7, 2021
Peer-review started: June 7, 2021
First decision: September 1, 2021
Revised: September 16, 2021
Accepted: November 28, 2021
Article in press: November 28, 2021
Published online: January 7, 2022
Abstract

Rheumatoid arthritis (RA) is an autoimmune disease characterized by proliferative synovitis, which can cause cartilage and bone damage as well as functional limitations. Disease-modifying anti-rheumatic drugs have significantly improved the prognosis of RA patients. However, people with RA, when combined with hepatitis B virus (HBV) infection, may experience reactivation of HBV during treatment with anti-rheumatic drugs. The outcome of HBV reactivation (HBVr) varies from liver inflammation to liver failure, while insufficient HBV screening in RA patients has been reported in various countries. Therefore, it is necessary to identify patients at high risk before starting immunosuppressive therapy. The immune response plays an important role in anti-HBV infection. However, most anti-rheumatic drugs exert an inhibitory effect on the body’s immune system, resulting in HBVr. Therefore, it is necessary to conduct a comprehensive evaluation based on host factors, viral factors, and drug factors. In this paper, we summarize the mechanism of HBVr, the risk of HBVr caused by anti-rheumatic drugs, and the appropriate diagnosis and treatment process for RA patients so that clinicians can have a more comprehensive understanding of HBVr in RA patients.

Keywords: Rheumatoid arthritis, Hepatitis B virus reactivation, Disease-modifying antirheumatic drugs, Risk factors

Core Tip: The application of anti-viral drugs and anti-rheumatic drugs improves the prognosis of patients with hepatitis B virus (HBV) infection and rheumatoid arthritis (RA). However, the reactivation of HBV in RA patients has not attracted enough attention. Although the HBV infection rate in RA patients is not high, once HBV reactivation (HBVr) occurs, it will cause serious consequences. Therefore, patients with HBV infection should undergo comprehensive evaluation before anti-rheumatic drug treatment. This paper summarizes the mechanism of HBVr, the risk of HBVr caused by anti-rheumatic drugs, and the appropriate diagnosis and treatment process for RA patients.