Methotrexate Therapy in Rheumatoid Arthritis Patients Infected with Chronic Hepatitis B or C.


  • Angkhana Norasetthada


    A 74-years-old male rheumatoid arthritis patient who was positive for HBs antigen and for HBe antibody showed liver dysfunction and therefore methotrexate therapy was discontinued. Liver function continued progression. Serologic studies were positive for HBs antigen, HBe antigen, anti-HBe antibody  and anti-HBc antibody.  HCV- RNA was undetectable. Sudden reactivation of the immune system by discontinuation of methotrexate may have led to the attack on infected cells. Even when antibodies to hepatitis Be antigen are present, methotrexate therapy should be caution in patients who have chronic infection with hepatitis B. Monitoring of liver function test and HBV-DNA should be consider.

    This article will review safety of methotrexate therapy, guideline for monitoring liver toxicity, methotrexate therapy in rheumatoid arthritis patients infected with chronic hepatitis B or C, and hepatitis linked to B virus infection after withdrawal of low dose methotrexate therapy.

Keywords; Rheumatoid Arthritis, Methotrexate, Hepatitis B, hepatitis C.





Case Report