Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Adherence with Screening Guidelines for Hepatitis B and C Testing Among U.S. Veterans with Rheumatoid Arthritis (RA)
Stoerner1, Scott A., Mikuls2, Ted R., Reimold3, Andreas M., Cannon4, Grant W.
The Centers for Disease Control and Prevention (CDC) recommend screening for all hepatitis B markers prior to immunosuppressive therapy for rheumatologic disorders. Hepatitis B and C screening is recommended by the American College of Rheumatology (ACR) prior to starting methotrexate or leflunomide in patients with defined risk factors for hepatitis. There have been reports of reactivated hepatitis B with immunosuppression. The purpose of this study was to determine adherence with these screening guidelines in U.S. Veterans with RA and determine the indication for hepatitis testing when undertaken.
Study subjects included participants in the Veterans Affairs Rheumatoid Arthritis (VARA) Registry from the Dallas, Salt Lake City, and Omaha active collection sites(n=305). The Computerized Patient Record System (CPRS) was used to obtain hepatitis risk factors, ALT/AST values, rheumatologic medications, and hepatitis serologies. When hepatitis serologies were obtained, clinic notes from multiple physicians were reviewed to determine the clinical indication behind this testing. These indications were then classified into the following categories: screening in adherence with the ACR and CDC guidelines, elevated ALT/AST of unknown etiology, and unknown. Hepatitis C had an additional category for those serologies obtained to help diagnose hepatitis C associated arthritis.
Sixty-five (21.3%) patients were tested for a hepatitis B serology. The indications for hepatitis B testing were 35 (53.8%) for screening, 16 (24.6%) for elevated ALT/AST of unknown etiology, and 14 (21.5%) unknown. Hepatitis C testing was done in 136 (44.6%) of patients. The indications for hepatitis C testing included 53 (39.0%) for screening, 19 (14.0%) for elevated ALT/AST of unknown etiology, 53 (39.0%) for diagnosis of hepatitis C arthritis, and 11 (8.1%) for other. The presence and/or absence of risk factors for hepatitis B and/or C infection could not be consistently identified in the current chart review. One hundred and ten (36.1%) patients received biologic therapy, while 267 (87.5%) patients received either methotrexate or leflunomide. One (0.3%) patient tested positive for hepatitis B and 11 (3.6%) patients tested positive for hepatitis C.
Adherence with CDC screening guidelines for hepatitis B in this population was low. Our review could not ascertain the presence of hepatitis B and/or C risk factors to sufficiently determine if ACR guidelines were being followed. The higher rate of testing for hepatitis C in comparison to hepatitis B appeared to the result of increased diagnostic testing for hepatitis C associated arthritis. Hepatitis B was noted to be rare among this population. These results support the need for greater evaluation of these guidelines in clinical practice to determine their best application and impact.
To cite this abstract, please use the following information:
Stoerner, Scott A., Mikuls, Ted R., Reimold, Andreas M., Cannon, Grant W.; Adherence with Screening Guidelines for Hepatitis B and C Testing Among U.S. Veterans with Rheumatoid Arthritis (RA) [abstract]. Arthritis Rheum 2009;60 Suppl 10 :313