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Rheumatoid arthritis biologic therapy — SCE Rheumatology MCQ

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HardInflammatory ArthritisRheumatoid arthritis biologic therapySCE Rheumatology

A patient being considered for rituximab is HBsAg negative, anti-HBc positive and has detectable low-level HBV DNA. What is the safest plan?

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Correct answer: B — Begin entecavir or tenofovir before the first rituximab infusion

B-cell depletion carries a high hepatitis-B-reactivation risk. Evidence of prior infection, especially detectable HBV DNA, requires specialist virology or hepatology planning and antiviral prophylaxis before rituximab, with continued biochemical and virological monitoring.

Reference: BSR biologic DMARD safety guideline in inflammatory arthritis — executive summary (Published 2019; update in development): https://academic.oup.com/rheumatology/article/58/2/220/5076445; BNF: rituximab (Current BNF monograph, accessed 30 July 2026): https://bnf.nice.org.uk/drugs/rituximab/