SCREENING for latent tuberculosis (TB), hepatitis C virus (HCV), and occult hepatitis B virus (HBV) is critical before initiating biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in patients with rheumatoid arthritis (RA), according to a recent clinical audit conducted in Pakistan. The study underscores the value of stringent pre-treatment screening protocols to mitigate the risk of infectious disease reactivation during immunosuppressive therapy.
Researchers retrospectively analyzed 353 patients from four rheumatology centers in Lahore, Pakistan, who met ACR/EULAR 2010 criteria for RA and began b/tsDMARD therapy between November 2019 and March 2024. The cohort was predominantly female (79.3%), with a mean age of 47.55 years. All patients underwent baseline screening for latent TB, HCV, and HBV prior to treatment initiation.
Documentation of latent TB screening was impressively high at 98%. Notably, 20.2% of patients tested positive and were successfully treated for latent TB without experiencing reactivation during subsequent immunosuppressive therapy. For HBV, 14.7% of patients showed serologic evidence of prior exposure, while 5.1% had active infection, all of whom received appropriate management. HCV screening identified 9.6% of patients as antibody-positive; however, none demonstrated active infection requiring treatment based on HCV RNA analysis.
The study’s findings highlight the importance of early infection detection in regions where the burden of TB and viral hepatitis remains elevated. Although compliance with screening protocols was high, the authors noted opportunities for further improvement in documentation and follow-up, particularly regarding infection reactivation monitoring.
This audit serves as a reminder to rheumatology practices globally of the essential role of infectious disease screening prior to the use of b/tsDMARDs. Tailoring pre-treatment evaluation to the local epidemiologic landscape ensures patient safety and optimal outcomes during immunosuppressive therapy.
Reference:
Qamar HY et al. Clinical Audit of screening Latent TB, Hepatitis-C, and Occult Hepatitis-B in Rheumatoid arthritis’ patients starting biologic or targeted synthetic DMARDS. Pak J Med Sci. 2025;41(6):1763-1769.
