Rheumatoid arthritis and viral hepatitis. Tactics of a rheumatologist. Literature review

Rheumatoid arthritis (RA) is an autoimmune disease that can be accompanied by complex liver involvement. The diagnosis and differentiation of these conditions are often complicated by the rarity of liver biopsies and the similarity of symptoms to other liver diseases. Viral hepatitis B and C in the context of rheumatoid arthritis can mimic rheumatological manifestations, further complicating timely diagnosis and worsening the prognosis for patients with rheumatoid arthritis. This literature review aims to systematize knowledge and assess the risks associated with the treatment of rheumatoid arthritis in patients with viral hepatitis B and C. Additionally, the article aims to provide recommendations for screening and treatment of viral hepatitis in these patients. The review is based on the analysis of available literature for the last ten years, including clinical trials, meta‑analyses, systematic reviews, and recommendations for the treatment of viral hepatitis in patients with rheumatoid arthritis. According to the literature, liver involvement in patients with rheumatoid arthritis can be caused by the disease itself, its treatment, or viral infections. Research results emphasize the importance of regular monitoring of liver function and screening for viral hepatitis B and C before starting rheumatoid arthritis treatment and during the use of immunosuppressive drugs. The integration of screening for viral hepatitis B and C into standard medical protocols for patients with rheumatoid arthritis before starting immunosuppressive therapy is essential. The timely detection of these infections is crucial because the treatment of hepatitis and immunosuppressive therapy for rheumatoid arthritis are interconnected and require a comprehensive approach. Adaptation of treatment depending on the status of viral infection is necessary to minimize liver risks and optimize the outcomes of rheumatoid arthritis treatment.