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ANA on Anti-TNF — SCE Rheumatology MCQ

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HardAutoimmune SerologyANA on Anti-TNFSCE Rheumatology

A patient with rheumatoid arthritis is due rituximab. HBsAg is negative, anti-HBc is positive and anti-HBs is positive; liver tests are normal. What is the safest interpretation and plan?

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Correct answer: E — Arrange hepatology-led HBV-reactivation prevention before rituximab

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · E = shown as D · A = shown as E

A is correct. Anti-HBc positivity indicates previous HBV exposure, not vaccination alone, and B-cell depletion can reactivate infection even when HBsAg is initially negative. Hepatology-led prophylaxis or a tightly defined monitoring strategy is required before treatment. B misreads anti-HBc. C and D mistake baseline HBsAg for immunity from reactivation. E omits the relevant virus.

Reference: BNF: rituximab: https://bnf.nice.org.uk/drugs/rituximab/