Can I Use Biologics for Psoriatic Arthritis with Reactive HBc IgG?

Hello, doctor. I would like to inquire about the use of biologics for psoriatic arthritis?

Hello, doctor.
I have psoriatic arthritis, and one out of three doctors has applied for a biologic agent for me (currently under review).
However, one of my blood test results shows HBc IgG for the hepatitis B virus core antigen at 5.87 (reactive).
Since my follow-up appointment is not yet due, I would like to ask if this test result means I am not suitable for using the biologic agent.
Additionally, do I need to see a gastroenterologist for further evaluation? Thank you.

Ms. Wu, 50~59 year old female. Ask Date: 2024/01/05

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
A positive HBc-IgG indicates that you have had a past infection and may still have latent hepatitis B virus.
You can still use biologics, but it is important to regularly monitor the hepatitis B virus load to check for any reactivation during treatment, allowing for early intervention if necessary.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is concerned about your health.

Reply Date: 2024/01/05

More Info

When considering the use of biologics for psoriatic arthritis (PsA) in the context of a reactive HBc IgG test, it is essential to understand the implications of this result and the necessary precautions. A reactive HBc IgG indicates that you have been exposed to the hepatitis B virus (HBV) at some point in your life, which may suggest a past infection. However, it does not necessarily mean that you currently have an active infection or that you are at immediate risk of reactivation.

Before starting biologic therapy, it is crucial to evaluate your liver health, especially in the context of HBV. Biologics can suppress the immune system, which may increase the risk of HBV reactivation in individuals who have a history of HBV infection. Therefore, it is standard practice to conduct a thorough assessment of HBV status, including HBV DNA levels, to determine if the virus is currently active. If the virus is dormant and there are no signs of active infection, you may still be eligible for biologic therapy, but with careful monitoring.

In your case, since you have a reactive HBc IgG, it is advisable to consult with a hepatologist or a gastroenterologist specializing in liver diseases. They can perform additional tests, such as HBV DNA quantification and liver function tests, to assess the risk of reactivation and the overall health of your liver. If there is evidence of active HBV infection, antiviral therapy may be initiated before starting biologics to mitigate the risk of reactivation.

In summary, while a reactive HBc IgG does not automatically disqualify you from using biologics for psoriatic arthritis, it does necessitate further evaluation of your HBV status and liver function. Consulting with a liver specialist is a prudent step to ensure that you receive safe and effective treatment for your psoriatic arthritis while managing the potential risks associated with your HBV history. Regular monitoring during biologic therapy will also be essential to detect any changes in your liver health or HBV status promptly.

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