Skip to main content

Advertisement

Log in

Different patterns of disease manifestations of parvovirus B19-associated reactive juvenile arthritis and the induction of antiphospholipid-antibodies

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Children with rheumatic oligo- and polyarthritis frequently establish persistent parvovirus B19 infections, which may be associated with the production of antiphospholipid antibodies. Reported in this paper are the data of five girls with polyarticular rheumatic diseases of different types and persistent parvovirus B19 infection associated in four cases with the presence of antibodies against phospholipids. Clinical parameters, virus load, and antiphospholipid-IgG levels were determined during an observation period up to 92 months. In two patients, erythema infectiosum preceded the development of arthritis and B19 viremia persisted. Two other girls showed antibodies against parvoviral structural proteins at time of the manifestation of the rheumatic disease. Subsequent samples also revealed persistent B19 infection. In the fifth patient, parvovirus B19-specific IgG antibodies were detected for the first time after 120 months of progressing disease at an age of 11 1/2 years. Five years later, quantitative polymerase chain reaction (PCR) revealed viral DNA. In a synovial tissue specimen subsequently obtained, parvovirus B19 structural proteins could be detected by immunohistochemistry. Three of five patients recovered completely without severe sequels. One patient is in remission under immunosuppressive therapy. The fifth patient suffers from progressive erosions despite intensive therapeutical efforts. In consequence, parvovirus B 19 should generally be taken into consideration as a trigger of various forms of juvenile arthritis and persistence of infection should be evaluated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

aPL IgG:

antiphospholipid antibodies

anti-β2GPI IgG:

antibodies against β2-glycoprotein I

NSAID:

nonsteroidal anti-inflammatory drugs

TCHA:

triamcinolone hexaacetonid intraarticularly injected

VP1:

viral protein 1

VP2:

viral protein 2

NS1:

non structural protein 1

References

  1. Heegaard ED, Brown KE (2002) Human parvovirus B19. Clin Microbiol Rev 15:485–505

    Article  PubMed  Google Scholar 

  2. Kerr JR, Modrow S (2006) Human and primate erythrovirus infections and associated disease. In: Berns KI (ed) Parvoviruses. Hodder Arnold, London, Great Britain, pp 385–416

    Google Scholar 

  3. Lehmann HW, Kühner L, Beckenlehner K, Müller-Godeffroy E, Heide KG, Küster RM, Modrow S (2002) Chronic human parvovirus B19 infection in rheumatic disease of childhood and adolescence. J Clin Virol 25:135–143

    Article  PubMed  CAS  Google Scholar 

  4. Lehmann HW, Knöll A, Küster R-M, Modrow S (2003) Frequent infection with a viral pathogen, parvovirus B19, in rheumatic diseases of childhood. Arthritis Rheum 48:1631–1638

    Article  PubMed  Google Scholar 

  5. Nocton JJ, Miller LC, Tucker LB, Schaller JG (1993) Human parvovirus B19-associated arthritis in children. J Pediat 122:186–90

    Article  PubMed  CAS  Google Scholar 

  6. Oguz F, Akdeniz C, Ünüvar E, Kücükbasmaci Ö, Sidal M (2002) Parvovirus B19 in the acute arthropathies and juvenile rheumatoid arthritis. J Paediatr Child Health 38:358–362

    Article  PubMed  CAS  Google Scholar 

  7. von Landenberg P, Lehmann HW, Knöll A, Dorsch S, Modrow S (2003) Antiphospholipid antibodies in pediatric and adult patients with rheumatic disease are associated with parvovirus B19 infection. Arthritis Rheum 48:1939–1947

    Article  Google Scholar 

  8. Liefeldt L, Plentz A, Klempa B, Kershaw O, Endres AS, Raab U, Neumayer HH, Meisel H, Modrow S (2005) Recurrent high level parvovirus B19/genotype 2 viremia in a renal transplant recipient analyzed by real-time PCR for simulataneous detection of genotypes 1 to 3. J Med Virol 75:161–169

    Article  PubMed  CAS  Google Scholar 

  9. Söderlund M, von Essen R, Haapasaari J, Kiistala U, Kiviluoto O, Hedman K (1997) Persistence of parvovirus B19 DNA in young patients with and without chronic arthropathy. The Lancet 349:1063–1065

    Article  Google Scholar 

  10. Cassinotti P, Siegel G (1997) Quantitative evidence for persistence of human parvovirus B19 DNA in an immunocompetent individual. Eur J Clin Microbiol Infect Dis 19:886–887

    Article  Google Scholar 

  11. Norja P, Hokynar K, Aaltonen LM, Chen R, Ranki A, Partio EK, Kiviluoto O, Davidkin I, Leivo T, Eis-Hübinger AM, Schneider B, Fischer HP, Tolba R, Vapalahti O, Vaheri A, Söderlund-Vernermo M, Hedman K (2006) Bioportfolio: lifelong persistence of variant and prototypic erythrovirus DNA genomes in human tissue. PNAS 103:7450–7453

    Article  PubMed  CAS  Google Scholar 

  12. Oliveira SA, Camacho LA, Pereira AC, Faillace TF, Setubal S, Nascimento JP (2002) Clinical and epidemiological aspects of human parvovirus B19 infection in an urban area in Brazil. Mem Inst Oswaldo Crus 97:965–970

    Google Scholar 

  13. Harel L, Straussberg R, Rudlich H, Cohen AH, Amir J (2000) Raynaud's phenomenon as a manifestation of parvovirus B19 infection: case reports and review of parvovirus B19 rheumatic and vasculitic syndromes. Clin Infect Dis 30:500–503

    Article  PubMed  CAS  Google Scholar 

  14. Dorsch S, Liebisch G, Kaufmann B, von Landenberg P, Hoffmann JH, Drobnik W, Modrow S (2002) The VP1 unique region of parvovirus B19 and its constitutent phospholipase A2-like activity. J Virol 76:2014–2018

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

The work was supported by the European Community (EU contract QLK2-CT-2001-00877). The authors thank Mikrogen GmbH, Munich, FRG for the donation of Recom-Blot, and Recom-Well tests, Anette Rohrhofer for excellent technical assistance and H.-G. Faßbender for immunohistochemistry of synovial tissue specimen.

Conflict of interests

None declared.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hartwig W. Lehmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lehmann, H.W., Plentz, A., von Landenberg, P. et al. Different patterns of disease manifestations of parvovirus B19-associated reactive juvenile arthritis and the induction of antiphospholipid-antibodies. Clin Rheumatol 27, 333–338 (2008). https://doi.org/10.1007/s10067-007-0718-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-007-0718-7

Keywords

Navigation