Hepatitis B Serology in Patients with Rheumatic Diseases

Martin Feuchtenberger*, Arne Schäfer, Axel Philipp Nigg, Michael Rupert Kraus
University of Wuerzburg - Medizinische Klinik und Poliklinik II Würzburg, Germany

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© Feuchtenberger et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at Medizinische Klinik II, Kreiskliniken Altötting-Burghausen, Rheumatology and Clinical Immunology, Krankenhausstr. 1, 84489 Burghausen, Germany; Tel: +49(0)8677/880261; Fax: +49(0)8677/880263; E-mail:



Only limited data are available on the prevalence of hepatitis B in patients with proven rheumatic diseases and thus the risk of reactivation under immunosuppressive therapy.


To analyse hepatitis B serology in patients with rheumatic diseases prior to therapy.


In total, 1,338 patient records were analysed for HBsAg, HBsAb and HBcAb in a cross-sectional, single-centre study between 2011 and 2015 at first presentation. Data acquisition was realized using electronic patient files created during routine care. The main variables considered as predictors for HBV reactivation included (i) the exact type of rheumatic disease and (ii) the therapeutically induced immunosuppression.


Overall, 5.9% of patients (n=79) had proven contact with hepatitis B (HBcAb positive), and HBsAb were not detected in 1.3% (n=18). The rate of vaccinated subjects was 7.8%. HBsAg was detected in 3 patients (0.2%). In addition, 70.3% of patients were treated during the course of rheumatologic disease previously or currently with glucocorticoids, 85.2% with disease-modifying anti-rheumatic drugs (DMARDs) and 20.1% with a biologic agent (e.g., anti-IL-6, anti-TNFalpha, anti-CD20, CTLA4Ig or anti-IL-12/23).


Prevalence of hepatitis B serostatus in the analysed rheumatic patients regarding HBs-Ag and HBcAb with or without HBsAb prior to therapy does not differ from the data published for the general population in Germany. However, the rate of hepatitis B vaccinated patients was lower. In general, a significant portion of patients (5.9%) has been exposed to HBV and therefore exhibited an increased risk of reactivation of hepatitis B when undergoing immunosuppressive therapy.

Keywords: HBcAb, HBsAb, HBsAg, HBV, Hepatitis B, Immunosuppression, Reactivation, Rheumatic disease.