Seroprevalence of parvovirus B 19 IgG in children affected by juvenile idiopathic arthritis

Parvovirus (PV) B19 is the causative agent of the childhood disease erythema infectiosum. An association of PV B19 with chronic arthropathies, sometimes resembling rheumatoid arthritis or juvenile idiopathic arthritis (JIA), has repeatedly been described. Other studies, however, have failed to identify any such relationship. In order to study further whether there is a link between PV B19 and JIA, we determined the prevalence of PV B19 specific IgG antibodies in serum samples from children with rheumatoid diseases and compared it with the prevalence in unaffected children We reasoned that if there is an association between PV B19 and JIA, then the prevalence of PV B19 IgG in the children with JIA should be higher than in the control group. PV B19 IgG status was tested in 406 children with JIA and related diseases, and in 146 children constituting a control group. The percentage of PV B19 IgG positive children was not significantly elevated in the disease subgroups compared with age-matched control groups. In conclusion, our findings do not support the hypothesis that human parvovirus B19 is involved in the pathogenesis of JIA. Background Parvovirus (PV) B19, the causative agent of the childhood disease erythema infectiosum (fifth disease), was identified in 1975. Since then a large spectrum of diseases caused by or associated with PV B19 has been recognized (for review [1,2]). In addition to erythema infectiosum, nonspecific febrile illnesses and asymptomatic courses are common. Furthermore, the clinical spectrum of PV B19 includes haematological, neurological and cardiovascular manifestations. Infection during pregnancy may result in hydrops fetalis. Arthralgias and acute arthritis are well known complications of acute PV B19 infection in children and in adults [3]. An association of PV B19 with chronic arthropathies, sometimes resembling rheumatoid arthritis or juvenile idiopathic arthritis (JIA), has also been described, but other studies have been unable to corroborate these findings. It therefore remains unclear whether there is an aetiological or pathogenic link between PV B19 and rheumatoid arthritis or JIA (for review [4]). The term JIA encapsulates a heterogeneous group of rheumatic diseases, which – for most subtypes – is distinct from adult rheumatoid arthritis [5]. Manifesting as early as in the first year of life, childhood arthritis can be a serious disease that affects not only motor neurone but also psychosocial development. Autoimmune features have been noted especially in two subgroups, namely enthesitis related arthritis and early onset pauciarticular arthritis (EOPA). Infectious diseases have long been suspected as being trigger factors for the initial manifestation of arthritis and subsequent flare ups, and various bacteria and viruses have been implicated in this regard [6-10]. In particular, Still's disease in childhood has been associated with PV B19; in fact, in some children affected by Still's disease the erythematous rash resembles that of erythema infectiosum [11,12]. In order to evaluate further the possible link between PV B19 and JIA, we determined the prevalence of PV B19 specific IgG antibodies in serum samples from children with rheumatic diseases and compared it with the prevalence in unaffected