Cansu Döndü U, Kalifoglu Timuçin, Korkmaz Cengiz
Division of Rheumatology, Department of Internal Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
J Rheumatol. 2008 Mar;35(3):421-4. Epub 2008 Jan 15.
To evaluate the short-term course of chronic hepatitis B and C under treatment with etanercept (ETN) associated with different disease modifying antirheumatic drugs (DMARD).
Patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) receiving anti-tumor necrosis factor-a (TNF-a) were retrospectively reviewed for the presence of hepatitis B or C serology, liver function tests, liver biopsy findings, and the relevant outcomes in terms of viral load.
We identified 5 relevant cases receiving ETN, 3 RA patients with chronic hepatitis C, another RA patient with dual infection by B and C, and one AS patient with hepatitis B. Four patients met the American College of Rheumatology criteria for RA. The patient with AS fulfilled the modified New York diagnostic criteria for AS. In Case 1, ETN was started after having discontinued a-interferon and ribavirin due to viral clearance of hepatitis C. These patients had not received prophylactic antiviral therapy while being treated with ETN. Viral replication increased in 2 patients to an insignificant level, remained negative in 2, and decreased in the remaining one. No significant rise in patients' liver transaminases could be determined during followup.
We observed reactivation of hepatitis C virus infection in 2 of 4 patients while they were receiving ETN with DMARD without antiviral prophylaxis.
评估在接受与不同改善病情抗风湿药（DMARD）联合使用的依那西普（ETN）治疗时，慢性乙型和丙型肝炎的短期病程。
对接受抗肿瘤坏死因子-α（TNF-α）治疗的类风湿关节炎（RA）和强直性脊柱炎（AS）患者进行回顾性研究，以确定其乙肝或丙肝血清学检查结果、肝功能测试、肝活检结果以及病毒载量方面的相关结果。
我们确定了5例接受ETN治疗的相关病例，3例患有慢性丙型肝炎的RA患者，另1例同时感染乙肝和丙肝的RA患者，以及1例患有乙肝的AS患者。4例患者符合美国风湿病学会的RA标准。AS患者符合AS的改良纽约诊断标准。在病例1中，由于丙肝病毒清除，在停用α干扰素和利巴韦林后开始使用ETN。这些患者在接受ETN治疗期间未接受预防性抗病毒治疗。2例患者的病毒复制增加至无显著水平，2例患者的病毒复制仍为阴性，其余1例患者的病毒复制减少。随访期间未发现患者肝转氨酶有显著升高。
我们观察到，在未进行抗病毒预防的情况下，4例患者中有2例在接受ETN联合DMARD治疗时出现丙肝病毒感染再激活。
