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Italian Consensus Recommendations for the management of hepatitis C infection in patients with rheumatoid arthritis

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Sebastiani M1, Milazzo L2, Atzeni F3, Vacchi C1, Manfredi A1, Quartuccio L4, Scirè C5, Gaeta GB6, Lapadula G7, Armignacco O8, Tavio M9, D'Angelo S10, Meroni P11, Bazzichi L12, Grassi W13, Mathieu A14, Mastroianni C15, Sagnelli E16, Santantonio T17, Uberti Foppa C18, Puoti M19, Sarmati L20, Airò P21, Epis OM22, Scrivo R23, Gargiulo M24, Riva A3, Ciancio G25, Zehender G26, Taliani G15, Meroni L3, Sollima S3, Sarzi-Puttini P2, Galli M3. Mod Rheumatol. 2018 Dec 22:1-23. doi: 10.1080/14397595.2018.1558918. [Epub ahead of print]


Author information 1 a Rheumatology Unit, Department of Medical and Surgical Science , University of Modena , Azienda Policlinico of Modena , Italy. 2 b Infectious Diseases Unit , University of Milano, Luigi Sacco Hospital , Milan , Italy. 3 c Rheumatology Unit , L. Sacco University Hospital , Milan , Italy. 4 d Department of Medical and Biological Sciences , Rheumatology Clinic, University of Udine , Udine , Italy. 5 e Epidemiology Unit , Italian Society for Rheumatology (SIR) , Milan , Italy. 6 f Infectious Diseases and Viral Hepatitis Unit, Department of Internal and Specialistic Medicine , Second University of Naples , Naples , Italy. 7 g Department of Medicine - Rheumatology Unit , Medical School, University of Bari , Bari , Italy. 8 h Infectious Disease Unit , Belcolle Hospital , Viterbo , Italy. 9 i Unit of Emerging and Immunosuppressed Infectious Diseases, Department of Gastroenterology and Transplantation , Azienda Ospedaliero-Universitaria "Ospedali Riuniti" , Torrette Ancona , Italy. 10 j Rheumatology Department of Lucania , San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera , Potenza , Italy. 11 k Division of Rheumatology, Department of Clinical Sciences and Community Health , Gaetano Pini Orthopedic Institute, University of Milan , Milan , Italy. 12 l Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy. 13 m Department of Rheumatology , Università Politecnica delle Marche , Ospedale "C. Urbani" , Jesi Ancona , Italy. 14 n Rheumatology Unit, University Clinic and AOU of Cagliari , Cagliari , Italy. 15 o Infectious Diseases Unit, Department Public Health and Infectious Disease , "Sapienza" University of Rome , Rome , Italy. 16 p Department of Mental Health and Public Medicine , Second University of Naples , Naples , Italy. 17 q Clinic of Infectious Diseases, University of Foggia , Foggia , Italy. 18 r Department of Infectious Diseases , San Raffaele Scientific Institute, Università Vita-Salute , Milan , Italy. 19 s Department of Infectious Diseases , AO Niguarda Ca' Granda , Milano , Italy. 20 t Clinical Infectious Diseases, Tor Vergata University , Rome , Italy. 21 u Rheumatology and Clinical Immunology Unit , Spedali Civili of Brescia , Brescia , Italy. 22 v Rheumatology Unit, A.O. Ospedale Niguarda Cà Granda , Milan , Italy. 23 w Department of Internal Medicine and Medical Specialties-Rheumatology Unit , Sapienza University of Rome , Rome , Italy. 24 x Third Department of Infectious Diseases- D. Cotugno Hospital- AORN dei Colli , Naple , Italy. 25 y Rheumatology Unit, Department of Medical Sciences , University of Ferrara and Sant'Anna University Hospital , Ferrara , Italy. 26 z Chair of Hygiene, University of Milan , Milano , Italy.


OBJECTIVES: The recent itroduction of direct-acting antiviral agents (DAAs) which can eliminate Hepatitis C virus (HCV) had revoluzionized the treatment of HCV infections also in a complex clinical setting such as the patients with rheumatoid arthritis (RA). HCV elimination is also opportune due to the availability of more efficient immunosuppressive drugs, whose effect on the course of HCV infection is largely unknown.

METHODS: Consensus process was endorsed by the Italian Society of Rheumatology (SIR) and the Italian Society of Infectious and Tropical Diseases (SIMIT) to review the available evidences and produce practical, hospital-wide recommendations. The consensus panel consisted of 18 infectious diseases consultants, 20 rheumatologists and one clinical epidemiologist, who used the criteria of the Oxford Centre for Evidence-based Medicine to assess the quality of the evidences and the strength of their recommendations.

RESULTS: A core-set of statements about management of patients with RA and infection by HCV have been developed to help clinicians in their clinical practice.

CONCLUSIONS: A screening for HCV should be performed in all RA patients and it is mandatory before starting an immunsuppressive therapy. Finally, a DAA treatment should be considered in all HCV-infected patients.