Author(s)

Osamu Noguchi¹, Yukio Nakamura^2,3, Hiroyuki Kato³

¹Department of Rheumatology, Gennoki Clinic, Ina, Japan.
²Department of Orthopaedic Surgery, Showa Inan General Hospital, Komagane, Japan.
³Department of Orthopaedic Surgery, School of Medicine, Shinshu University, Matsumoto, Japan.

Background: Hepatitis after the reactivation of hepatitis B virus (HBV) has been recognized serious in the patients with rheumatoid arthritis (RA) treated with biologics. Objectives: The objective of the present study was to search some common background which might be relevant to the host factors that provoke such a serious hepatitis. Methods: We retrospectively collected and analyzed all data of serum alanine aminotransferase (ALT) levels in selected patients with RA at random. Results: A significant association (P < 0.001) between methotrexate (MTX) therapy and elevated serum ALT level was found only in the anti-HBcAb-negative RA group. The mean serum ALT level was significantly higher (P < 0.001) in patients with than without MTX therapy in the anti-HBcAb-negative RA group, although no significant difference was found (P = 0.73) in the anti-HBcAb-positive RA group. In addition, the anti-HBcAb-positive RA patients showed significantly lower mean serum level of ALT (P < 0.01) than anti-HBcAb-negatives provided they are na?ve with biologics. But no significant difference between anti-HBcAb-positives and -negatives in the mean serum level of ALT was found among patients experienced with biologics (P < 0.8). Conclusions: The anti-HBcAb-positive RA group showed the suppression of MTX-induced elevations in serum ALT level. However, this suppression was not found in patients experienced in the treatment with biologics, although it was preserved in those who had not experienced biologics. Failure of this suppressive mechanism of ALT in anti-HBcAb-positive RA patients treated with biologics could be possibly associated with serious hepatitis after the reactivation of HBV infection.

Rheumatoid Arthritis, De Novo Hepatitis B, MTX-Induced Liver Injury, ALT, Biological Agents

Noguchi, O. , Nakamura, Y. and Kato, H. (2018) Suppression of Methotrexate-Induced Elevations in the Serum Alanine Aminotransferase Level of Patients with Rheumatoid Arthritis Who Had Prior Hepatitis B Infection. Health, 10, 531-541. doi: 10.4236/health.2018.105042.