Background Parvovirus infections have been reported to account for up to twelve percent of patients with new onset arthritis. Therefore, parvovirus infection is a relevant differential diagnosis in very early polyarthritis.
Objectives To define the clinical features of arthritis associated with parvovirus infections, analyzing factors that may narrow the group of patients for whom parvovirus serology may be useful.
Methods The study included all 122 patients for whom parvovirus serology was ordered by the division of Rheumatology from January 2007 through December 2011. Eleven patients with new parvovirus B19 infection were found, based on specific IgM and IgG antibodies detected by enzyme immunoassay (parvovirus arthritis group) and confirmed by PCR in the majority of cases. These patients were compared to the other 111 patients with negative IgM anti-parvovirus antibodies (control group).
Results Patients were similar in both female predominance (10/11 in the parvovirus arthritis, 79/111 in the control group) and age (median 45 (range 21-59) vs. 45 (18-83) years). Patients with parvovirus arthritis had a more acute course with early Rheumatology presentation (median 28 (2-45) days vs. 38 (1-4383) days) and complete resolution in all eleven cases, as compared to 60/107 patients in the control group (p=0.0031). In fact, 9/11 parvovirus patients were free of symptoms within 3 months. Of the 11 parvovirus patients, 10 had polyarthritis, as compared to 59/108 in the control group. In the subgroup of 10 patients, for whom specific information was available, finger joints were most frequently (9/10) affected, followed by knee (7/10), wrist (6/10), ankle (5/10), toe (5/10) and shoulder (3/10) joints. Laboratory disorders included anaemia (3/11 vs. 26/111), lymphocytopenia (4/11 vs. 34/111), neutrophilia (2/11 vs. 23/111), monocytosis (1/11 vs. 8/111) and thrombocytosis (2/11 vs. 10/111). Liver enzymes were elevated in 2/11 parvovirus patients (vs. 14/111) and LDH was increased in 4/11 (vs. 15/111). Rheumatoid factor was positive in only 1/11 patients with parvovirus infection (vs. 13/108); no patient (0/11) had positive anti-CCP antibodies (vs. 7/102). In contrast, positive ANA were found in 8/11 patients (vs. 36/103). Most (9/11) patients with acute parvovirus infection reported prodromal symptoms before the onset of arthritis, as compared to only 22/111 in the control group did (p<0.0001). Prodromal symptoms included respiratory infection in 5, fever or flulike symptoms and rash in 2 patients each, and edema in 1 patient.
Conclusions Parvovirus associated arthritis is predominantly a symmetrical, polyarticular arthritis with a very acute onset and a rapidly self-limiting course of disease. Our data suggest that prodromal symptoms before the onset increase the likelihood of parvovirus arthritis in very early polyarthritis.
Disclosure of Interest None declared
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