# Clinical Audit of screening Latent TB, Hepatitis-C, and Occult Hepatitis-B in Rheumatoid arthritis’ patients starting biologic or targeted synthetic DMARDS

## TL;DR

This study shows the importance of screening for infections before treating rheumatoid arthritis patients with certain drugs, especially in regions with high infection rates.

## Contribution

The study provides real-world data on pre-treatment screening compliance and infection prevalence in rheumatoid arthritis patients in Pakistan.

## Key findings

- 98% compliance with latent TB screening, with 20.2% testing positive and no TB reactivation during treatment.
- 14.7% tested positive for HBV antibodies, and 5.1% had active HBV infections, all treated appropriately.
- 9.6% tested positive for HCV, but none required further treatment based on HCV RNA results.

## Abstract

To highlight the importance of pre-treatment screening in Rheumatoid arthritis’ patients starting biologic or targeted synthetic DMARDS.

This retrospective multicentric clinical audit was conducted at the Department of Rheumatology, Central Park Teaching Hospital and affiliated Rheumatology Clinics in Lahore, Pakistan. All patients enrolled gave an informed consent, meeting the ACR/EULAR 2010 criteria for RA, aged 17 years or above, and initiating b/ tsDMARDS between November, 2019 and March, 2024. Data for this clinical audit was retrieved from biologic and targeted synthetic DMARDS registry of consortium of four centers including two academic centers. Data was retrospectively reviewed and analyzed using SPSS version 26.

The cohort comprised 353 patients, predominantly female 280 (79.3%) with a mean age of 47.55 years. Before starting treatment, patients were screened for latent TB, HCV, and HBV. Compliance with latent TB documentation was 98%, with 20.2% of patients testing positive and receiving appropriate treatment, without any reactivation of TB during treatment. Screening for occult HBV revealed 14.7% tested positive for antibodies, with 5.1% showing active infection, all of whom were treated. For HCV, 9.6% tested positive, but none required further treatment as per HCV RNA.

This clinical audit emphasizes the need of thorough screening protocols with early detection and management of latent infections to optimize treatment outcomes in RA particularly in regions with specific infectious disease burdens like Pakistan. Our documentation of compliance with pre-screening was high but there remains room for improvement. We aim to clinical audit for reactivation of these infections also in future.