How do you approach DMARD therapy in patients with rheumatoid arthritis and chronic hepatitis B?  

Patients with hepatitis B core positivity, surface antigen positivity, and positive PCR for viral DNA, should be treated with entecavir prior to starting any DMARD. Given the DNA PCR is positive too, that indicates active viral replication and they may need treatment for a while before starting anyt...

The 2021 ACR guidelines (Fraenkel et al., PMID 34101387) are helpful but I would expand on Dr. @Sarah L. Dill’s comments. Since many patients with chronic hepatitis B require treatment for 12 months or longer, I would consider initiation of hydroxychloroquine, sulfasalazine as cDMARD early if ...