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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The reactivation of hepatitis B virus &#40;HBV&#41; infection is defined as an increase in HBV replication in a patient with an inactive or resolved hepatitis &#40;usually accompanied by increased serum transaminase levels&#41;&#46; Most reported cases have occurred in patients with hematologic malignancies after chemotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> Recently&#44; there have been reports of HBV reactivation in patients with rheumatoid arthritis after treatment with biological therapies such as rituximab &#40;RTX&#41;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Although most cases of HBV reactivation have occurred in patients with serology indicating chronic HBV infection&#44; patients with resolved HBV infection can develop this complication&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 77 year old patient with a history of seropositive and erosive rheumatoid arthritis of 12 years of evolution&#44; receiving the first cycle of RTX in February 2008&#46; Serology for HBV in 2001 was HBsAg negative and anti-HBc positive&#44; compatible with resolved hepatitis B&#46; The patient received methotrexate from 2002 to 2004 and the treatment was stopped by the appearance of oral ulcers&#46; In 2005&#44; treatment was started with infliximab 3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg every 8 weeks with good response&#59; after one year of treatment&#44; the patient presented a lack of response in March 2006 and it was suspended due to multiple episodes of lung infections and switched to etanercept 50<span class="elsevierStyleHsp" style=""></span>mg weekly&#46; From 2005 to 2008&#44; serum levels of ALT transaminase &#40;GPT&#41; ansd AST &#40;GOT&#41;&#44; remained stable&#44; but new virus serology was not requested&#46; Due to poor control of symptoms &#40;disease activity score &#91;DAS&#93; 28 joints 6&#46;43&#41; the patient was treated with RTX &#40;2&#215;1000&#41; in February 2008&#46; He received the second cycle of RTX in August 2008&#46; After treatment&#44; the DAS 28 was 3&#46;79&#44; but in July 2009 the patient had anicteric hepatitis with ALT &#40;GPT&#41; 555<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; AST &#40;GOT&#41; 349<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; GGT 81<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; total bilirubin 0&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and HBsAg&#43;&#44; HBeAg&#43;&#44; albumin<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; 70&#37; TP&#44; 99<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>platelets&#47;mm<span class="elsevierStyleSup">3</span> and HBV DNA was &#62;8<span class="elsevierStyleHsp" style=""></span>log<span class="elsevierStyleHsp" style=""></span>U&#47;ml &#40;virus genotype was A&#41;&#46; This data indicated the presence of a reactivation of chronic hepatitis B with a moderate degree of hepatocellular failure&#46; At this point the patient quickly was sent to the hepatologist and began treatment with entecavir&#46; After one month of therapy&#44; HBV was DNA down to 5&#46;4<span class="elsevierStyleHsp" style=""></span>log<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#46; Five months later HBV-DNA was only 1&#46;74<span class="elsevierStyleHsp" style=""></span>U&#47;ml &#40;3&#46;24<span class="elsevierStyleHsp" style=""></span>log<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#41;&#44; but remained positive until February 2011&#46; The biochemical response was faster&#44; with normalization of transaminases after only 8 months of therapy&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">HBV reactivation after immunosuppressive treatment is a serious adverse effect which can be identified and prevented&#46; There have been various guidelines and recommendations but the management of HBV occult infection with only anti-HBc positivity remains unclear today&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> The consensus on RTX use in rheumatoid arthritis recommends monitoring of transaminases and&#47;or HBV DNA<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in patients without active HBV with HBsAg negative but anti-HBc-positive antibodies&#44; as in our patient&#46; In patients who had increased levels of HBV DNA during therapy with RTX&#44; one should consider associating antiretroviral therapy&#46; The exact mechanism of HBV reactivation is unknown and although it is not a very common complication&#44; there have been cases of fulminant hepatitis that were seen even after 6 months of cessation of therapy with RTX&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Prophylactic treatment with antiretroviral therapy significantly reduces the incidence of HBV reactivation after treatment with RTX&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In conclusion&#44; strict monitoring should follow liver biochemistry&#44; HBsAg&#44; HBV-DNA in the anti-HBc positive and HBsAg negative patients during and 6 months after treatment with RTX&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; cycles RTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">HBV serology before RTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">HBV serology after RTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Antiretroviral therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Evolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pyrpasopoulou et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F 56 RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Only RTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg&#43; HBeAg&#43; HBeAb&#8722; HBV DNA&#62;9&#46;6&#215;10<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>U&#47;ml Normal serum transaminases treatment with lamivudine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg&#43; HBeAg&#43; HBV DNA&#62;1&#46;1&#215;10<span class="elsevierStyleSup">8</span><span class="elsevierStyleHsp" style=""></span>U&#47;ml ASAT 110<span class="elsevierStyleHsp" style=""></span>U&#47;l ALT 150<span class="elsevierStyleHsp" style=""></span>U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tenofovir and lamivudine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 months later HBV load was 46<span class="elsevierStyleHsp" style=""></span>U&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ghr&#233;nassia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M 78 RA and mantle cell lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RTX&#43;prednisone 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg HBcAb&#43;normal serum transaminases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg &#43;HBeAg&#43; HBV DNA<span class="elsevierStyleMonospace">&#62;</span>7<span class="elsevierStyleHsp" style=""></span>log<span class="elsevierStyleHsp" style=""></span>U&#47;ml ASAT 177<span class="elsevierStyleHsp" style=""></span>U&#47;l ALT 421<span class="elsevierStyleHsp" style=""></span>U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Entecavir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 months later HBV load was undetectable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M 77 RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RTX&#43;prednisone<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg HBcAb&#43;normal serum transaminases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg&#43; HBeAg&#43; HBV DNA&#62;8<span class="elsevierStyleHsp" style=""></span>log<span class="elsevierStyleHsp" style=""></span>U&#47;ml ASAT 349<span class="elsevierStyleHsp" style=""></span>U&#47;l ALT 555<span class="elsevierStyleHsp" style=""></span>U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Entecavir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 months later HBV load was undetectable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Previous Cases of HBV Reactivation in RA Patients Following Treatment With RTX&#46;</p>"
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
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Letter to the Editor
Reactivation of Hepatitis Virus B Infection in a Patient With Rheumatoid Arthritis After Treatment With Rituximab
Reactivación del virus de la hepatitis B en un paciente con artritis reumatoide tras el tratamiento con rituximab
Tarek Carlos Salman-Montea,
Corresponding author
tareto4@gmail.com
98383@parcdesalutmar.cat

Corresponding author.
, María Pilar Lisbonaa, Montserrat García-Retortillob, Joan Maymóa
a Servicio de Reumatología, Parc de Salut Mar, Hospital del Mar, IMIM, Universidad Autónoma de Barcelona, Barcelona, Spain
b Sección de Hepatología, Parc de Salut Mar, Hospital del Mar, IMIM, Universidad Autónoma de Barcelona, Barcelona, Spain
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patients with resolved HBV infection can develop this complication&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 77 year old patient with a history of seropositive and erosive rheumatoid arthritis of 12 years of evolution&#44; receiving the first cycle of RTX in February 2008&#46; Serology for HBV in 2001 was HBsAg negative and anti-HBc positive&#44; compatible with resolved hepatitis B&#46; The patient received methotrexate from 2002 to 2004 and the treatment was stopped by the appearance of oral ulcers&#46; In 2005&#44; treatment was started with infliximab 3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg every 8 weeks with good response&#59; after one year of treatment&#44; the patient presented a lack of response in March 2006 and it was suspended due to multiple episodes of lung infections and switched to etanercept 50<span class="elsevierStyleHsp" style=""></span>mg weekly&#46; From 2005 to 2008&#44; serum levels of ALT transaminase &#40;GPT&#41; ansd AST &#40;GOT&#41;&#44; remained stable&#44; but new virus serology was not requested&#46; Due to poor control of symptoms &#40;disease activity score &#91;DAS&#93; 28 joints 6&#46;43&#41; the patient was treated with RTX &#40;2&#215;1000&#41; in February 2008&#46; He received the second cycle of RTX in August 2008&#46; After treatment&#44; the DAS 28 was 3&#46;79&#44; but in July 2009 the patient had anicteric hepatitis with ALT &#40;GPT&#41; 555<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; AST &#40;GOT&#41; 349<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; GGT 81<span class="elsevierStyleHsp" style=""></span>U&#47;l&#44; total bilirubin 0&#46;7<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and HBsAg&#43;&#44; HBeAg&#43;&#44; albumin<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; 70&#37; TP&#44; 99<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>platelets&#47;mm<span class="elsevierStyleSup">3</span> and HBV DNA was &#62;8<span class="elsevierStyleHsp" style=""></span>log<span class="elsevierStyleHsp" style=""></span>U&#47;ml &#40;virus genotype was A&#41;&#46; This data indicated the presence of a reactivation of chronic hepatitis B with a moderate degree of hepatocellular failure&#46; At this point the patient quickly was sent to the hepatologist and began treatment with entecavir&#46; After one month of therapy&#44; HBV was DNA down to 5&#46;4<span class="elsevierStyleHsp" style=""></span>log<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#46; Five months later HBV-DNA was only 1&#46;74<span class="elsevierStyleHsp" style=""></span>U&#47;ml &#40;3&#46;24<span class="elsevierStyleHsp" style=""></span>log<span class="elsevierStyleHsp" style=""></span>U&#47;ml&#41;&#44; but remained positive until February 2011&#46; The biochemical response was faster&#44; with normalization of transaminases after only 8 months of therapy&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">HBV reactivation after immunosuppressive treatment is a serious adverse effect which can be identified and prevented&#46; There have been various guidelines and recommendations but the management of HBV occult infection with only anti-HBc positivity remains unclear today&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> The consensus on RTX use in rheumatoid arthritis recommends monitoring of transaminases and&#47;or HBV DNA<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in patients without active HBV with HBsAg negative but anti-HBc-positive antibodies&#44; as in our patient&#46; In patients who had increased levels of HBV DNA during therapy with RTX&#44; one should consider associating antiretroviral therapy&#46; The exact mechanism of HBV reactivation is unknown and although it is not a very common complication&#44; there have been cases of fulminant hepatitis that were seen even after 6 months of cessation of therapy with RTX&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Prophylactic treatment with antiretroviral therapy significantly reduces the incidence of HBV reactivation after treatment with RTX&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In conclusion&#44; strict monitoring should follow liver biochemistry&#44; HBsAg&#44; HBV-DNA in the anti-HBc positive and HBsAg negative patients during and 6 months after treatment with RTX&#46;</p></span>"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Salman-Monte TC&#44; Lisbona MP&#44; Garc&#237;a-Retortillo M&#44; Maym&#243; J&#46; Reactivaci&#243;n del virus de la hepatitis B en un paciente con artritis reumatoide tras el tratamiento con rituximab&#46; Reumatol Clin&#46; 2014&#59;10&#58;196&#8211;197&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">F&#58; female&#44; M&#58; male&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No&#46; cycles RTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">HBV serology before RTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">HBV serology after RTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Antiretroviral therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Evolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pyrpasopoulou et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F 56 RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Only RTX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg&#43; HBeAg&#43; HBeAb&#8722; HBV DNA&#62;9&#46;6&#215;10<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>U&#47;ml Normal serum transaminases treatment with lamivudine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg&#43; HBeAg&#43; HBV DNA&#62;1&#46;1&#215;10<span class="elsevierStyleSup">8</span><span class="elsevierStyleHsp" style=""></span>U&#47;ml ASAT 110<span class="elsevierStyleHsp" style=""></span>U&#47;l ALT 150<span class="elsevierStyleHsp" style=""></span>U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tenofovir and lamivudine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 months later HBV load was 46<span class="elsevierStyleHsp" style=""></span>U&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ghr&#233;nassia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M 78 RA and mantle cell lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RTX&#43;prednisone 10<span class="elsevierStyleHsp" style=""></span>mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg HBcAb&#43;normal serum transaminases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg &#43;HBeAg&#43; HBV DNA<span class="elsevierStyleMonospace">&#62;</span>7<span class="elsevierStyleHsp" style=""></span>log<span class="elsevierStyleHsp" style=""></span>U&#47;ml ASAT 177<span class="elsevierStyleHsp" style=""></span>U&#47;l ALT 421<span class="elsevierStyleHsp" style=""></span>U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Entecavir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 months later HBV load was undetectable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Case&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M 77 RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RTX&#43;prednisone<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg HBcAb&#43;normal serum transaminases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HBsAg&#43; HBeAg&#43; HBV DNA&#62;8<span class="elsevierStyleHsp" style=""></span>log<span class="elsevierStyleHsp" style=""></span>U&#47;ml ASAT 349<span class="elsevierStyleHsp" style=""></span>U&#47;l ALT 555<span class="elsevierStyleHsp" style=""></span>U&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Entecavir&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 months later HBV load was undetectable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Previous Cases of HBV Reactivation in RA Patients Following Treatment With RTX&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatitis B virus reactivation in lymphoma patients with prior resolved hepatitis B undergoing anticancer therapy with or without rituximab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:5 [
                            0 => "W&#46; Yeo"
                            1 => "T&#46;C&#46; Chan"
                            2 => "N&#46;W&#46;Y&#46; Leung"
                            3 => "F&#46;K&#46;F&#46; Lam WY&#44; Mo"
                            4 => "M&#46;T&#46; Chu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2008.18.0182"
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                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reactivation of hepatitis B virus during RTX treatment of a patient with follucilar limphoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;H&#46; Yang"
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                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Haematol"
                        "fecha" => "2008"
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              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reactivation of hepatitis B virus following rituximab-based regimens&#58; a serious complication in both HBsAg-positive and HBsAg-negative patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Pei"
                            1 => "C&#46; Chen"
                            2 => "C&#46; Lee"
                            3 => "M&#46; Wang"
                            4 => "M&#46; Ma"
                            5 => "T&#46;H&#46; Hu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00277-009-0806-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Hematol"
                        "fecha" => "2010"
                        "volumen" => "89"
                        "paginaInicial" => "255"
                        "paginaFinal" => "262"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19697028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reactivation of chronic hepatitis B virus infection following rituximab administration for rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Pyrpasoppoulou"
                            1 => "S&#46; Douma"
                            2 => "T&#46; Vassiliadis"
                            3 => "S&#46; Chatzimichailidou"
                            4 => "A&#46; Triantafyllou"
                            5 => "S&#46; Aslanidis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00296-009-1202-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatol Int"
                        "fecha" => "2011"
                        "volumen" => "31"
                        "paginaInicial" => "403"
                        "paginaFinal" => "404"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19830433"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reactivation of resolved hepatitis B during rituximab therapy for rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Ghr&#233;nassia"
                            1 => "A&#46; M&#233;knian"
                            2 => "S&#46; Rouaghe"
                            3 => "N&#46; Granne"
                            4 => "O&#46; Fain"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jbspin.2011.07.003"
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Article information
ISSN: 21735743
Original language: English
DOI:10.1016/j.reumae.2013.12.007
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