Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Cyuuou-Ku, Niigata 951-8510, Japan.
Rheumatol Int. 2012 Apr;32(4):1059-63. doi: 10.1007/s00296-009-1344-2. Epub 2010 Jan 9.
In this report, we describe a case of a 48-year-old Japanese woman who is a hepatitis B (HB) carrier with rheumatoid arthritis (RA). She had the following antibody profile: HBs Ag(+), HBs Ab(-), HBe Ag(-), HBe Ab (+), HBc Ab(-) and undetectable HBV-DNA level. She was treated with auranofin, salazosulfapyridine, and bucillamine. Finally, she was treated with D: -penicillamine, but her disease activity remained elevated. Prophylactic treatment of entecavir 0.5 mg daily was started in March 2008 and all disease-modifying anti-rheumatic drugs were stopped. After 2 weeks, etanercept monotherapy was started at 25 mg subcutaneously once a week. Significant improvement in clinical parameters of disease activity and well being was observed. Serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), and HB virus viral load did not change significantly. Serum ALT, AST, and HB virus viral load were followed-up at every 3-month intervals, from initiation of therapy up to 24 months after the start of treatment with etanercept. We have also summarized the course of nine RA patients who received etanercept and were HB carriers or had chronic HB according to our literature search. Based on the results of our study, treatment of these patients with etanercept co-administered with lamivudine or entecavir appears to be safe.
在本报告中，我们描述了一例 48 岁的日本乙型肝炎（HB）携带者伴类风湿关节炎（RA）的病例。她的抗体谱如下：HBsAg(+)、HBsAb(-)、HBeAg(-)、HBeAb(+)、HBcAb(-)和 HBV-DNA 水平不可检测。她接受了金诺芬、柳氮磺胺吡啶和布西拉明治疗。最终，她接受了 D：-青霉胺治疗，但疾病活动度仍升高。2008 年 3 月开始每天预防性给予恩替卡韦 0.5mg，同时停用所有改善病情的抗风湿药物。两周后，每周一次皮下给予依那西普 25mg 单药治疗。观察到临床疾病活动和生存参数的显著改善。血清丙氨酸氨基转移酶（ALT）、血清天冬氨酸氨基转移酶（AST）和乙型肝炎病毒载量无明显变化。从开始治疗到开始依那西普治疗后 24 个月，每 3 个月监测一次血清 ALT、AST 和乙型肝炎病毒载量。根据我们的文献检索，我们还总结了 9 例接受依那西普治疗且为乙型肝炎携带者或慢性乙型肝炎患者的 RA 患者的病程。根据我们的研究结果，联合使用拉米夫定或恩替卡韦治疗这些患者的依那西普似乎是安全的。
