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1、AmericanCollegeofRheumatology2008RecommendationsfortheUseofNonbiologicandBiologicDisease-ModifyingAntirheumaticDrugsinRheumatoidArthritisLivercontraindications.Abnormallivertransaminases.Whenthelevelsoflivertransaminases(aspartateaminotransferaseoral
2、anineaminotransferase)weregreaterthan2-foldtheupperlimitofnormal,theTFPrecommendedthattheinitiationorresumptionofleflunomide,methotrexate,andsulfasalazinewascontraindicated(althoughrecommendationsonwhentodiscontinuearenotprovided).Therearealargenumber
3、ofstudiesaddressingleflunomide(48,50,61,132,153,154),methotrexate(41,43,46,48,49,130–132,134–137,154–179),andsulfasalazine(44,56,60,61,63,153,180,181).AcutehepatitisBorC.InthepresenceofacutehepatitisBorC,treatmentwithmethotrexate,leflunomide,sulfasala
4、zine,minocycline,andbiologicagentswascontraindicatedbytheTFP.ChronichepatitisBorC.InthepresenceofchronichepatitisBorC(treatedoruntreated),theseverityofcompromisedliverfunctionwasconsideredbytheTFPasakeyfactorinmakingtherapeuticdecisions.TheChild-Pughs
5、coringsystemforchronicliverdisease(182–184)wasusedbasedontheadviceofourexpertadvisorinthefieldofhepatology.Thissystemisaliverdiseaseseverityinstrumentusedtodeterminetheprognosisofchronicliverdisease.Itisbasedontheserumalbuminandtotalbilirubinlevels,th
6、eprothrombintime,thepresenceorabsenceofascites,andthepresenceorabsenceofencephalopathy.Child-PughclassCisassociatedwitha1-yearsurvivalrateof50%,whereaspatientswithChild-PughclassesAorBhavea5-yearsurvivalrateof70–80%.TherecommendationsfornonbiologicDMA
7、RDsinpatientswithchronichepatitisBorCwerestratifiedbasedonthetypeofhepatitis,theChild-Pughgrade,andwhetherornotantiviralagentstotreathepatitishadbeeninitiated(Table2).WhentreatingpatientswithchronichepatitisBorC,physiciansneedtoconsidertherisksandbene
8、fitsforallDMARDs.ForcertainDMARDs,suchashydroxychloroquine,theTFPdiscusseduncommonbutreportedconcernsabouttheuseoftheseagentsinthesettingofsevereunderlyingliverinjury,definedasChild-PughclassC(185,186).InthesettingoftreatedchronichepatitisB,le
