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1. DON'T FORGET TO CHECK FOR HEPATITIS B IN YOUR PATIENTS ABOUT TO BE TREATED WITH IMMUNOSUPPRESSANTS

   • Daniel G. Arkfeld, md

   USC Keck School of Medicien

   It is with great interest that I read Dr. Sorrell and coauthors article entitled "National Institutes of Health Consensus Development Conference Statement: Management of Hepatitis B." As a rheumatologist I have seen several hepatitis B infected patients who have been treated with immunosupressants for rheumatic conditions. These patients were asymptomatic with varying risk factors and usually normal or mildly elevated liver transaminases. However, this puts them at risk for fulminant hepatitis especially when withdrawing such therapy. We currently check for hepatitis B exposure in patients who are at risk and need to be placed on an immunosuppressant. This is especially true with anti-TNF agents such as infliximab and adalimumab and anti-CD 20 B cell therapy with rituximab. One should also consider routinely checking all patients being placed on a biological agent to prevent this potentially catastrophic complication.

   Conflict of Interest:

   None declared

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   Published January 20, 2009