Hepatitis B virus reactivation in a Juvenile Rheumatoid arthritis patient under treatment and its successful management: a complicated case

• Published in: Rheumatology international 2013-05, Vol.33 (5), p.1345-1349
• Main Authors: Durmus, Oguz, Tekin, Levent, Carli, Alparslan Bayram, Cakar, Engin, Acar, Ali, Ulcay, Asim, Dincer, Umit, Kiralp, Mehmet Zeki
• Format: Article
• Language: English
• Subjects: Antiviral Agents - therapeutic use; Arthritis, Juvenile - blood; Arthritis, Juvenile - diagnosis; Arthritis, Juvenile - drug therapy; Arthritis, Juvenile - immunology; Biomarkers - blood; Drug Substitution; Etanercept; Guanine - analogs & derivatives; Guanine - therapeutic use; Hepatitis B; Hepatitis B - blood; Hepatitis B - diagnosis; Hepatitis B - drug therapy; Hepatitis B - immunology; Hepatitis B - virology; Hepatitis B virus - drug effects; Hepatitis B virus - immunology; Hepatitis B virus - pathogenicity; Humans; Immunoglobulin G - therapeutic use; Immunosuppressive Agents - adverse effects; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Opportunistic Infections - blood; Opportunistic Infections - diagnosis; Opportunistic Infections - drug therapy; Opportunistic Infections - immunology; Opportunistic Infections - virology; Pathogens; Receptors, Tumor Necrosis Factor - therapeutic use; Rheumatoid arthritis; Rheumatology; Short Communication; Time Factors; Treatment Outcome; Virus Activation - drug effects; Young Adult
• ISSN: 0172-8172; 1437-160X
• DOI: 10.1007/s00296-011-2244-9

Juvenile rheumatoid arthritis is a common chronic inflammatory disease in the childhood and it can differentiate rarely into spondiloarthropaties. It is one of the important causes of chronic pain and disability. Some of the drugs used for the treatment have immunosupressive activity. One of the serious side-effects of immunosupressive treatment is activation of opportunistic pathogens. Hepatitis B virus (HBV) is one of these pathogens, and the rate of carriers in the population is considerably high. It can cause liver damage and death if reactivated. Thus, the management of oppotunistic pathogens becomes a complex issue when treating rheumatic diseases with immunosupressive drugs. In this case report, we present a juvenile rheumatoid arthritis patient whose liver enzymes raised while he was under treatment and afterwards HBV reactivation was determined as the cause. When reactivation was detected, we started controlled antiviral therapy. We achieved successful clinical and laboratory results after adding biological agents to the treatment. Careful evaluation of the patients who have indication for immunosuppressive agents and regular follow-up in case of infection may be protective from severe morbidity and/or mortality.