I came across this article. It's pretty interesting...
Parvovirus may link to rheumatoid arthritis
July 25, 2005 FAMILY DOCTOR
Allen Douma, M.D. Tribune Media Services
Q: I’m approaching the one-year anniversary of a bout with a virus, which blood tests finally showed to be parvovirus B19. After 5 months of lingering symptoms, I was also “officially” diagnosed with rheumatoid arthritis.
I was the second of three women (that I know of) in a relatively isolated geographic area who were initially misdiagnosed. Our doctors thought it was most likely Lyme disease.
The rheumatologist put me on methotrexate. I am currently self-injecting Humira, which has definitely been more effective.
Is the incidence of Parvovirus B19 increasing? I’m also interested in the parvo/rheumatoid arthritis connection. Thanks for your help. I’ve learned a lot in reading your column. — P.F.
A: Studies have shown that as many as two-thirds of middle aged women have been infected with this virus, while other studies have found that as few as 20 percent of teenagers have had it. However, in my review of the medical literature I was unable to tell if the incidence of the parvovirus B19 is increasing.
For a long time, infection by parvovirus B19 has been associated most closely with erythema infectiosum (aka “fifth disease”). It occurs in young children, causing fiery red cheeks and a whitish circle around the mouth. This is followed by a rash on the trunk, malaise, headache and itching, but little fever.
Parvovirus B19 is also known to be associated with adverse effects on fetuses such as hydrops fetalis, aplastic anemia, and intrauterine fetal death. Recently this virus has shown up in tissue from inflamed hearts.
Before providing information about the possible connection between the parvovirus and rheumatoid arthritis (RA), I’ll provide information on RA.
As many as 5 million people in North America have rheumatoid arthritis. It usually starts before the age of 40 and affects three times as many women as men. But there are forms that can start in children.
RA is chronic inflammation that affects many tissues of the body but causes greater problems in the joints. A person’s immune system attacks and partially destroys cartilage, bone, ligaments and tendons.
Diagnosing rheumatoid arthritis depends on both the characteristic symptoms and medical tests. Joint stiffness is often preceded by malaise, fever and weight loss. Joint involvement typically begins in the fingers and toes, and works its way toward the shoulders and hips. This may happen very rapidly or take many years.
X-rays of rheumatic joints show thinning of the surrounding bone, erosion of the joint lining, and narrowing of the joint space. In addition, a blood test for rheumatoid factor is usually positive. But this test may be positive with other diseases as well.
RA is an autoimmune disease in which the immune system starts to attack and destroy specific cells in the body, especially those lining the joints. But the direct cause or causes that activate the immune system is unknown.
Symptoms of acute arthritis are also often present in adults who get infected with the parvovirus. And this virus is detected in the bloodstream in a higher percentage of those with rheumatic diseases like chronic arthritis. But since the virus has not been found in the joints themselves, it reinforces the autoimmune theory of RA. The evidence indicates that parvovirus is a strong suspect for at least one of the causes of RA.
Treating rheumatoid arthritis involves many components and requires active participation by the person. Although medications play an important role, other management activities are critical.
This begins with a thorough understanding of the disease, its treatment, and the physical and psychological impact it can have. To help minimize further damage, people with RA should rest and exercise the joints appropriately, lose weight if overweight, use heat and cold when indicated, and use splints judiciously.
More than 50 drugs, including aspirin, methotrexate and Humira have been shown to be effective. Start by using the least damaging (often less expensive) drugs. But if these are not effective, try one or more different drugs.
Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207; or contact him at DRFamily@aol.com
