Hepatitis B reactivation in a chronic hepatitis B surface antigen carrier with rheumatoid arthritis treated with infliximab and low dose methotrexate

Open Access
Publisher Website
Google Scholar
Abstract
A 49 year old man was diagnosed as having RA in January 1990. HBsAg, and HBe and HBc antibodies were positive, while HBe antigen and HBs antibodies were negative. From January 1990 to May 2000 he received several treatments consisting of different disease modifying antirheumatic drugs (DMARDs) (hydroxychloroquine, sulfasalazine, sodium aurothiomalate, and cyclosporin A) in addition to oral steroids (<10 mg/day of prednisone) and non-steroidal antiinflammatory drugs. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) remained persistently normal. However, response to these treatments was poor, and peripheral arthritis persisted. In June 2000 he began treatment with infliximab (6 mg/kg every eight weeks) associated with methotrexate (10 mg/week), with a good response of the joint signs and symptoms, as well as the inflammatory indices. In January 2002 he developed malaise, anorexia, fatigue, increased levels of AST (97 IU/l) and ALT (176 IU/l), and then he was admitted to our division.