Background Parvovirus B19 infection in adults has been associated with a variety of rheumatic manifestations and laboratory findings mimicking rheumatic disease.
Objectives To explore the clinical features of recent parvovirus B19 infection in adults and investigate the number of patients who fulfill the classification criteria for rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE).
Methods We performed a retrospective chart review of adult patients with newly-diagnosed parvovirus B19 infection at a community-based hospital in Japan from April 2006 to December 2013. Diagnosis was made with positive serum anti-parvovirus B19 IgM antibody measured by enzyme-linked immunosorbent assay.
Results Sixty patients were included (female, 77%; mean age, 39 years) with a mean follow-up of 118 weeks (range, 0-356). Mean disease duration was 34 days (range, 5-316) and mean duration of arthritis was 29 days (range, 7-140). The mean interval between development of the initial manifestation and the onset of arthritis was 4 days (range, 0-19). Arthritis of more than 6 weeks was seen in only one patient. A half of the patients (53%) had a recent history of exposure to people who had clinical manifestations of viral infection.
In our study population, predominant signs and symptoms were: arthritis/arthralgia (87%), skin rash (65%), edema (58%), fever (55%), and lymphadenopathy (32%). Regarding arthritis/arthralgia, 18 patients (30%) had physician-diagnosed arthritis, while 34 (57%) had arthralgia alone. Commonly involved joints were in the knee (68.4%), followed by wrist (58%), hand (55%), ankle (55%), and elbow (45%). The most frequent pattern of arthritis/arthralgia was polyarticular (83%). Ten patients (17%) had rash on the cheeks, and 5 others (8%) had characteristic lacy rash on the extremities. The most frequent type of rash was pruritic erythema on the upper and lower limbs. Laboratory findings included anemia (12/60, 20%), lymphocytopenia (41/57, 72%), elevated lactate dehydrogenase (32/55, 58%), positive anti-nuclear antibody (ANA) (30/33, 91%), and hypocomplementemia (13/29, 45%). Autoantibody to DNA and anti-phospholipid antibody were positive in 32% (6/19) and 54% (7/14) of the patients, respectively. Rheumatoid factor (RF) was not detected (0/38), while anti-CCP antibody (ACPA) was detected in 11% (2/18). Persistent infection was diagnosed in two patients. There is no significant difference in baseline characteristics between arthritis group and non-arthritis group.
Of all 60 patients, 12 patients fulfilled the 2012 SLICC SLE criteria (six patients met the 1997 revised ACR SLE criteria). Of 18 patients with arthritis, five patients fulfilled the 2010 ACR/EULAR RA criteria (one patient met the 1987 ACR RA criteria).
Conclusions Parvovirus B19 infection in adults often presents with acute polyarthritis and skin rash accompanied with lymphocytopenia, hypocomplementemia, and positive ANA. Our study demonstrated that 20% of adult patients with recent parvovirus B19 infection fulfill the SLE criteria and nearly a third of patients with arthritis fulfill the RA criteria. We should consider the possibility of parvovirus B19 infection in the differential diagnosis of SLE or early onset RA.
Disclosure of Interest : None declared
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