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Hepatitis B screening before biologic therapy — SCE Rheumatology MCQ

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HardRheumatological pharmacologyHepatitis B screening before biologic therapySCE Rheumatology

A 45-year-old woman is due to start adalimumab for psoriatic arthritis. Screening shows HBsAg negative, anti-HBc positive and anti-HBs positive; liver enzymes are normal. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Assess hepatitis B reactivation risk and arrange hepatology-guided monitoring or prophylaxis

The best answer is “Assess hepatitis B reactivation risk and arrange hepatology-guided monitoring or prophylaxis”. Assess hepatitis B reactivation risk and arrange hepatology-guided monitoring or prophylaxis is the most appropriate next step after the disease phenotype, previous treatment and safety constraints in the stem are considered. The remaining choices—“deprioritise the result because HBsAg is negative, after safety review”, “Give live attenuated vaccine after adalimumab starts, after specialist assessment”, “Start adalimumab in the absence of documenting viral status, with clinical reassessment”, “Treat with high-dose prednisolone before biologic therapy, within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG100 rheumatoid arthritis in adults: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations