Epidemiological characteristics of hepatitis B and C in patients with inflammatory arthritis: Implications from treasure database

Emine Duygu Ersözlü1, Mustafa Ekici2, Belkis Nihan Coşkun3, Suade Özlem Badak1, Emre Bilgin2, Umut Kalyoncu2, Burcu Yağız4, Yavuz Pehlivan3, Orhan Küçükşahin5, Abdulsamet Erden6, Dilek Solmaz7, Pamir Atagündüz8, Gezmiş Kimyon9, Cemal Beş10, Seda Çolak11, Rıdvan Mercan12, Timuçin Kaşifoğlu13, Hakan Emmungil14, Nilüfer Alpay Kanıtez15, Aşkın Ateş16, Süleyman Serdar Koca17, Sedat Kiraz2, İhsan Ertenli2

1Department of Internal Medicine, Division of Rheumatology, Adana City Training and Research Hospital, Adana, Türkiye
2Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Türkiy
3Department of Internal Medicine, Division of Rheumatology, Uludağ University, Bursa, Türkiye
4Department of Internal Medicine, Division of Rheumatology, Afyonkarahisar Hospital, Afyonkarahisar, Türkiye
5Department of Internal Medicine, Division of Rheumatology, Ankara Yıldırım Beyazıt Üniversitesi, Ankara, Türkiye
6Department of Internal Medicine, Division of Rheumatology, Ankara City Hospital, Ankara, Türkiye
7Department of Internal Medicine, Division of Rheumatology, Katip Çelebi University, Atatürk Eğitim ve Araştırma Hospital, Izmir, Türkiye
8Department of Internal Medicine, Division of Rheumatology, Marmara University, Istanbul, Türkiye
9Department of Internal Medicine, Division of Rheumatology, Mustafa Kemal University, Hatay, Türkiye
10Department of Internal Medicine, Division of Rheumatology, University of Health Sciences, Istanbul Başakşehir Cam and Sakura City Hospital, Istanbul, Türkiye
11Department of Internal Medicine, Division of Rheumatology, University of Health Sciences, Gülhane Faculty of Medicine, Ankara, Türkiye
12Department of Internal Medicine, Division of Rheumatology, Namık Kemal University, Tekirdağ, Türkiye
13Department of Internal Medicine, Division of Rheumatology, Osmangazi University, Eskişehir, Türkiye
14Department of Internal Medicine, Division of Rheumatology, Trakya University, Edirne, Türkiye
15Department of Internal Medicine, Division of Rheumatology, Koç University, Istanbul, Türkiye
16Department of Internal Medicine, Division of Rheumatology, Ankara University, Ankara, Türkiye
17Department of Internal Medicine, Division of Rheumatology, Fırat University, Elazığ, Türkiye

Keywords: HBV, HCV, rheumatic diseases, rheumatoid arthritis, spondyloarthritis, TReasure, viral hepatitis, viral reactivation.

Abstract

Objectives: This study aimed to evaluate the hepatitis B (HBV) and C (HCV) frequency and clinical characteristics among patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) who receive biological treatments.

Patients and methods: The observational study was conducted with patients from the TReasure database, a web-based prospective observational registry collecting data from 17 centers across Türkiye, between December 2017 and June 2021. From this database, 3,147 RA patients (2,502 males, 645 females; median age 56 years; range, 44 to 64 years) and 6,071 SpA patients (2,709 males, 3,362 females; median age 43 years; range, 36 to 52 years) were analyzed in terms of viral hepatitis, patient characteristics, and treatments used.

Results: The screening rate for HBV was 97% in RA and 94.2% in SpA patients. Hepatitis B surface antigen (HBsAg) positivity rates were 2.6% and 2%, hepatitis B surface antibody positivity rates were 32.3% and 34%, hepatitis B core antibody positivity rates were 20.3% and 12.5%, HBV DNA (deoxyribonucleic acid) positivity rates were 3.5% and 12.5%, and antibody against HCV positivity rates were 0.8% and 0.3% in RA and SpA patients, respectively. The HBsAg-positive patients were older and had more comorbidities, including hypertension, diabetes, and coronary artery disease. In addition, rheumatoid factor (RF) positivity was more common in HBsAg-positive cases. The most frequently prescribed biologic disease-modifying antirheumatic drugs were adalimumab (28.5%), etanercept (27%), tofacitinib (23.4%), and tocilizumab (21.5%) in the RA group and adalimumab (48.1%), etanercept (31.4%), infliximab (22.6%), and certolizumab (21.1%) in the SpA group. Hepatitis B reactivation was observed in one RA patient during treatment, who received rituximab and prophylaxis with tenofovir.

Conclusion: The epidemiological characteristics of patients with rheumatic diseases and viral hepatitis are essential for effective patient management. This study provided the most recent epidemiological characteristics from the prospective TReasure database, one of the comprehensive registries in rheumatology practice.

Citation: Duygu Ersözlü E, Ekici M, Coşkun BN, Badak SÖ, Bilgin E, Kalyoncu U, et al. Epidemiological characteristics of hepatitis B and C in patients with inflammatory arthritis: Implications from treasure database. Arch Rheumatol 2023;38(3):347-357.

Ethics Committee Approval

Ethics committee approval was received from Hacettepe University (KA17/058) in May 2017 and from the Turkish Ministry of Health (93189304-14.03.01) in October 2017. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

All authors contributed to study design, material preparation, data collection, analysis, interpretation and writting of the manuscript and take full responsibility for the integrity of the study and the final manuscript. All authors read and approved the final manuscript.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.