The ACR 2015 Rheumatoid Arthritis (RA) treatment guidelines were published this week and released after nearly a year of review and revision by the panel. The guideline committee recommends that individuals with RA and hepatitis be treated in the following manner:

Individuals with an established diagnosis of RA with moderate or high disease activity and evidence of active hepatitis B infection (HBsAg+ for greater than 6 months) and are receiving or have received effective antiviral treatment, are recommended to be treated the same as patients without this condition.

• Those with natural immunity from prior HBV exposure (HB core antibody and HB surface antibody positive and normal liver function tests), we recommend the same therapies as those without such findings as long as the patient’s viral load is monitored.
• For patients with chronic hepatitis B who are untreated, referral for antiviral therapy is appropriate prior to immunosuppressive therapy.

Individuals with an established diagnosis of RA with moderate or high disease activity and evidence of chronic hepatitis C virus (HCV) infection, who are receiving or have received effective antiviral treatment, are conditionally recommended to receive treatment the same as the patients without this condition.

Rheumatologists should work with gastroenterologists and/or hepatologists who would monitor patients and reassess the appropriateness of antiviral therapy, especially given the recent availability of highly effective therapy for HCV.

Chronic HCV patients not requiring or receiving antiviral treatment are conditionally recommended to receive DMARD therapy rather than TNFi. This recommendation is based on very little evidence and is mainly based on expert opinion.

Source: American College of Rheumatology. [Press release]. 2015 ACR Guideline for the Treatment of Rheumatoid Arthritis Now Available Online. Nov. 10, 2015.

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