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Rheumatoid Arthritis — SCE Rheumatology MCQ

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HardRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

Pre-biologic screening in a patient with rheumatoid arthritis shows positive hepatitis B surface antigen and undetectable HBV DNA. What is the best next step?

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Correct answer: B — Use hepatology assessment and antiviral prophylaxis planning

The best answer is “Use hepatology assessment and antiviral prophylaxis planning”. HBsAg positivity indicates current HBV infection and reactivation risk during immunosuppression even when DNA is initially undetectable. Antiviral choice and duration should be coordinated with hepatology according to the proposed agent. Ignoring the result, imposing a permanent contraindication, waiting for seroclearance or vaccinating established infection are inappropriate.

Reference: BSR biologic DMARD safety guideline: https://academic.oup.com/rheumatology/article/58/2/e3/5076446