INTEGRIN ALPHA2BBETA3 GENE POLYMORPHISM AND THE MICROVASCULAR SYSTEM IN SCLERODERMA

Background: Immunosuppression induced by drugs administrated to patients with autoimmune diseases can affect the course of HBV infection, both in terms of reactivation and precipitation of a pre-existing chronic hepatitis (1, 2). Anti TNF-α drugs have been recently reported to be safe in patients with potentially occult hepatitis B (3). Objectives: At the best of our knowledge, the role of traditional DMARDs in altering the course of HBV infection has not yet been assessed. In our study we evaluated this role. Methods: 148 non HCV-infected patients with autoimmune rheumatic disease (i.e. Rheumatoid arthritis, 78; psoriatic arthritis, 36; systemic vasculitides, 14; Sjogren syndrome and UCTD, 11; systemic lupus erythematosus, 9) were assessed for HBV markers at baseline and followed for 5-31 months (median 21 months). They were administered the following DMARDS: methotrexate (MTX)74; azatioprine 30; cyclosporine A (CyA) 16; leflunomide 12; mofetil mycophenolate 5; middle or high steroid dose 8; cyclophosphamide 1; MTX+CyA 2. Patients undergoing low-risk treatments(1), including hydroxychloroquine, sulfasalazine and low dose steroids were excluded. Results: At baseline 9 (6%) were HBsAg positive; 22 (15%) were HBsAb and HBcAb positive; 11 (7.4%) were HBcAb positive (without HBsAg or HBsAb); 5 (3.4%) were HBsAb positive (without HBcAb) because of a previous vaccination. During treatment, abnormal liver function test (LFT) were detected in 42 patients: 29(52.7%) were drug-related; 9 (16.4%) were due to a coexisting autoimmune liver dysfunction; 1 (1.8) was due to a steatosis; 3 (5.5%) were due to a HBV infection reactivation: 2 among the 9 HBsAg positive patients (22%), and 1 among the 33 potential occult HBV carriers (3%). Conclusions: Spontaneous flares in chronic hepatitis B have been reported (4). Zacharakis et al (5) found 4 cases (2%) of reactivation among 195 HBsAg positive inactive carriers. In our cohort 3 cases of HBV reactivation occurred (2 out of 9 HBsAg positive carriers, and 1 out of 33 potential occult carriers). National and International guidelines suggest a careful assessment of HBV infection in rheumatic patients undergoing immunosuppressive therapies. Our data support the safety of such drugs pointing out a low prevalence (3%) of HBV reactivation in potentially occult carriers.