Deparment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
J Korean Med Sci. 2018 May 10;33(23):e168. doi: 10.3346/jkms.2018.33.e168. eCollection 2018 Jun 4.
Rheumatoid arthritis (RA) treatment may differ according to hepatitis B state and consequently may bring about different arthritis outcomes. However, whether hepatitis B affects treatment outcome remains unclear. We investigated differences in change in arthritis activity between RA patients according to concomitant hepatitis B virus infection.
A retrospective medical chart review was performed by two rheumatologic fellows using single center data, from January 2000 to March 2015. Among RA patients older than 18 years, patients with comorbidities that could affect RA treatment aside from hepatitis B were excluded. Using 1:3 propensity score matching, 40 hepatitis B virus surface antigen (HBsAg)-positive patients and 112 HBsAg-negative patients were included in the study. Data were collected longitudinally using standardized electronic forms. The longitudinal relationship between HBsAg-positivity and RA activity was analyzed using generalized estimating equations.
RA activity showed time-dependent improvement. Reductions of swollen joint count over time were significantly larger in the HBsAg-negative group. However, changes in disease activity score in 28 joints with three variables (DAS28-3), tender joint count, erythrocyte sedimentation rate and C-reactive protein level did not differ between the groups. There were no differences in alanine aminotransferase level. HBsAg-positive patients were less likely to receive methotrexate (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.04-0.19; < 0.001) and more likely to receive sulfasalazine (OR, 3.67; 95% CI, 1.94-6.95; < 0.001).
RA medication use varied according to HBsAg-positivity. However, improvement in RA activity was not significantly affected by concomitant hepatitis B infection.
类风湿关节炎（RA）的治疗可能因乙型肝炎状态而异，因此可能会带来不同的关节炎结果。然而，乙型肝炎是否会影响治疗结果尚不清楚。我们调查了乙型肝炎病毒感染对 RA 患者关节炎活动度变化的影响。
两名风湿病研究员使用单中心数据进行了回顾性病历审查，时间范围为 2000 年 1 月至 2015 年 3 月。排除了除乙型肝炎以外还会影响 RA 治疗的合并症的 18 岁以上 RA 患者。通过 1：3 倾向评分匹配，纳入了 40 名乙型肝炎病毒表面抗原（HBsAg）阳性患者和 112 名 HBsAg 阴性患者。使用标准化电子表格进行了纵向数据收集。使用广义估计方程分析了 HBsAg 阳性与 RA 活动之间的纵向关系。
RA 活动显示出时间依赖性改善。HBsAg 阴性组的肿胀关节计数随时间的减少幅度明显更大。然而，两组之间的 28 个关节疾病活动度评分（DAS28-3）、压痛关节计数、红细胞沉降率和 C 反应蛋白水平的变化没有差异。丙氨酸氨基转移酶水平没有差异。HBsAg 阳性患者接受甲氨蝶呤治疗的可能性较低（比值比 [OR]，0.09；95%置信区间 [CI]，0.04-0.19； < 0.001），而接受柳氮磺胺吡啶治疗的可能性较高（OR，3.67；95% CI，1.94-6.95； < 0.001）。
RA 药物的使用因 HBsAg 阳性而异。然而，乙型肝炎合并感染并未显著影响 RA 活动的改善。
