Conway Richard, Doran Michele F, O'Shea Finbar D, Crowley Brendan, Cunnane Gaye
Department of Rheumatology, St. James Hospital, Dublin, Ireland,
Clin Rheumatol. 2014 Dec;33(12):1823-7. doi: 10.1007/s10067-014-2612-4. Epub 2014 Apr 13.
Identification of patients with exposure to viral hepatitis is an important part of the care of patients with inflammatory arthritis. This study was conducted to assess the extent of hepatitis B and C screening, and the prevalence of viral hepatitis in a cohort of patients with established rheumatoid arthritis (RA). The medical records of 100 consecutive RA patients were retrospectively analysed for screening of hepatitis B surface antigen, surface antibody and core antibody and hepatitis C antibody. A teaching session was then conducted with the rheumatology team, emphasising the rationale for viral hepatitis testing. We then prospectively analysed 100 more RA patients to see if hepatitis screening improved. In the initial 100 patients (21 % male, mean age 65 years), 85 % were taking methotrexate and 22 % biologic treatments. A complete hepatitis screen was present in 8 %, while 12 % had hepatitis B core antibody checked and 53 % had been tested for hepatitis C.The second cohort of patients was similar to the first in terms of demographics and treatment. A complete hepatitis screen was available in 63 %, while 65 % had hepatitis B core antibody checked and 81 % had been tested for hepatitis C.In total, we identified 4 new cases of positive hepatitis B core antibody, 11 cases of positive hepatitis B surface antibody and 1 case of positive hepatitis C antibody. Even in populations where hepatitis B or C is non-endemic, screening will reveal new cases. Educational initiatives are helpful in teaching staff to screen patients.
识别接触过病毒性肝炎的患者是炎性关节炎患者护理的重要组成部分。本研究旨在评估乙型和丙型肝炎筛查的程度，以及一组确诊类风湿关节炎（RA）患者中病毒性肝炎的患病率。对100例连续的RA患者的病历进行回顾性分析，以筛查乙肝表面抗原、表面抗体和核心抗体以及丙肝抗体。随后与风湿病团队进行了一次培训，强调了病毒性肝炎检测的基本原理。然后我们前瞻性分析了另外100例RA患者，以观察肝炎筛查是否有所改善。在最初的100例患者中（21%为男性，平均年龄65岁），85%正在服用甲氨蝶呤，22%正在接受生物治疗。8%的患者进行了完整的肝炎筛查，12%的患者检查了乙肝核心抗体，53%的患者进行了丙肝检测。第二组患者在人口统计学和治疗方面与第一组相似。63%的患者进行了完整的肝炎筛查，65%的患者检查了乙肝核心抗体，81%的患者进行了丙肝检测。我们总共发现了4例乙肝核心抗体阳性新病例、11例乙肝表面抗体阳性病例和1例丙肝抗体阳性病例。即使在乙型或丙型肝炎非流行地区，筛查也会发现新病例。教育举措有助于指导工作人员对患者进行筛查。
