Student guest post by D.F. Johnston

Many who have had the responsibility of taking care of man’s best friend hear “parvo” or “parvovirus” and their thoughts leap immediately to something Fido needed to be vaccinated for. But while there is a canine parvovirus, a human one known as parvovirus B19 also exists. Person-to-person transmission of parvovirus B19 is primarily through aerosol spread, although maternal-fetal and blood-borne spread is also possible [1]. It is important to note that B19 infection is not acquired from time spent playing fetch with Fido; the canine parvovirus and human parvovirus are species-specific [2].

In addition to asymptomatic infection or general flu-like symptoms, this single-stranded DNA virus can also cause rash (primarily in children) and, more commonly in adults, arthritis, especially in the fingers and hands but also in the wrists and ankles [1]. According to Colmegna and Alberts-Grill, 80% of adults experience joint pain from B19 infection [1] and arthritic symptoms are suffered 60% of the time in women as compared to 30% in men [3]. While most arthritis experience lasts approximately two weeks and resolves on its own, slightly less than one in five of those patients will continue to have chronic arthritis for a period ranging from months to years [1].

Interestingly, the chronic arthritis experienced following B19 infection is so similar to clinical presentation for rheumatoid arthritis (RA) that 50% of patients experiencing it meet the criteria for diagnosis of RA [4]. Difficulty in distinguishing between B19-chronic arthritis and RA is made even more difficult because interaction between B19 virus and the immune system leads to the production of several kinds of autoantibodies, including the rheumatoid factor used in diagnosis of RA [1].

The joint pain and inflammation associated with B19 is thought to be caused by multiple factors, including a viral protein that may act like a host enzyme that is involved in activation of immune-mediated inflammation [1]. One of the most significant proposed factors is molecular mimicry, where some part of the B19 virus recognized by the immune system is so similar in appearance to something in human joint tissues that the immune system mistakenly attacks joint tissue, resulting in the pain and arthritis associated with B19 infection [1]. This is an extremely important point since a similar mechanism is associated with RA and several studies found evidence of B19 infection in both patients with RA and lupus, which prompted investigations into a causal role of B19 in not just acute arthritis but RA as well as lupus [3].

Unfortunately, study results have been fairly contradictory in assessing parvovirus B19 as a causal component in RA or lupus. Some studies have tentatively suggested an association needing further investigation and others have more explicitly stated a causal role for B19 [3, 4]. Contrasted with this are several studies that conclude B19 is not a cause of RA or lupus [3, 4]. The problem with many of the studies trying to demonstrate the causal nature of B19 is that a large number focus on presence of either B19 or antibodies against B19 in people who already have the disease of interest [3, 4] which only shows that B19 and RA or lupus are both present, not that a person was first infected with B19 and then developed RA or lupus. Other studies are not even cross-sectional in nature but are case series [5] involving a small number of patients, which may be valuable for generating hypotheses but lack scientific rigor for testing the causal relationship. Given the fairly weak evidence demonstrating an association pitted against stronger data supporting no relationship, it appears that opinions generally come down on the side of either an unlikely causative role for B19 in RA or lupus [2, 3] or “inconclusive” data at this point [1]. Despite sharing the former conclusion, Naides still argues that the similarity between proposed mechanisms for B19-induced arthritis and rheumatoid arthritis leaves understanding the mechanism behind arthritis from B19 as an important method for potentially improved understanding of RA [2].

Whatever the role of parvovirus B19 in development of either rheumatoid arthritis or lupus, it does cause both acute and chronic forms of arthritis in addition to the general “flu-like symptoms” that are often encountered with infectious diseases. Despite the species-specific nature of canine and human parvoviruses, our susceptibility to B19 infection leaves us with one more experience we share with our four-legged friends.

Works Cited:

1. Colmegna, I. & N. Alberts-Grill. 2009. “Parvovirus B19: its role in chronic arthritis.” Rheum Dis Clin N Am, 35(1): 95-110.

2. Naides, S.J. “Rheumatic manifestations of parvovirus B19 infection.” Rheum Dis Clin N Am, 24(2): 375-401.

3. Moore, T.L. “Parvovirus-associated arthritis.” Curr Opin Rheumatol, 12(4): 289-94.

4. Lunardi, C., Tinazzi, E., Bason, C., Dolcino, M., Corrocher, R., & Puccetti, A. “Human parvovirus B19 infection and autoimmunity.” Autoimmun Rev, 8(2): 116-20.

5. Gran, J.T., Johnsen, V., Myklebust, G., & Nordbe, S.A. “The variable clinical picture of arthritis induced by human parvovirus B19.” Scand J Rheumatol, 24(3): 174-9.

Comments

  1. #1 Laura
    April 29, 2010

    I had Parvo almost 3 years ago, and now I have RA. My RA Factor has always been negative, but my knuckles have early erosions. I don’t present with the classic textbook signs of RA and have had a hard time getting to this diagnosis. I had to go to the Cleveland Clinic to get my doctor onboard with what I felt in my heart was wrong with me. Have you ever heard of this happening after a Parvo infection? I am 50, my Igg tends to run low at 528, and I have problem with memory cells.

  2. #2 Kelly
    June 20, 2010

    I am a 30 yr old otherwise healthy active adult who was diagnosed with parvovirus back in feb 2010. I have had severe debilitating pain for almost 5 months now, dr put me on high doses of prednisone with no results. I am wondering if there is any other medication that would help better than prednisone? My rheumatologist told me it’s just a matter of time until the virus goes away and that there is nothing else he can do!!! Pain medication does not help and here are days I can barely walk! If anyone knows of any medication please let me know!

  3. #3 Linda
    February 26, 2012

    I was diagnosed with Parvovirus back in Oct.2009. My # was high at 557. I was asked if anyone I was around had strep throat? I had to come back in two wks for a swab of my throat. What? I came out (-).Since it was (-) they left it alone. Now, here I am 2 yrs later with extreme back and neck pain. Massive disruptions involving my heart,joints,sleep,skin, memory etc.. keeps going. I think it still has to do with that damn parvovirus. Anyone else still experiencing any other major symptoms? Help!!!replys needed.

  4. #4 elaine kelly
    April 10, 2012

    At least fifteen years ago my son contracted “slapped cheek” virus. Acouple of weeks later both my hands and wrist joints began to hurt, swell, and eventually started to turn black. It was agony and I couldn’t bear anyone to even touch them. I went to casualty and was admitted to the hospital and promptly diagnosed by a consultant rheumatologist with “classic” acute RA. I underwent a variety of tests including blood tests and a radioactive xray. Splints were made for my wrists to be worn at night. I was incapacitated for at least two months.Eventually I was told that my blood test suggested I didnot in fact have RA but something fairly new called parvovirus which mimics the symptoms of RA. It was only at this point that i was asked if any of my children had had the “slapped cheek” virus. I appeared to recover although have suffered bad neck pain. I appear now to have gout in my heel, ankle and left wrist (also very painful and i can hardly walk (the pain at night is terrible) and i can’t tke anti-inflammatories because they make me sick. I am now wondering if this has anything to do with the parvovirus. I does anyone know if there is a connection. Info welcome. thanks …Elaine

  5. #5 Sharon T
    Ohio
    February 12, 2013

    I too was diagnosed with parvovirus, but long after I had the issue. I was put on Bactrim and I was allergic, as a result, I lost most of my skin and hair, then the real pain started. It would drift thoughout all my joints over the next month and a half. I finally had a full panel of tests done, and was sent to an RD. I now have RA for the rest of my life and my RD told me that the virus opened the door to RA and there is no closing it down. I am on meds to help with the joint pain and only have flares – it is a creeping disease and hard to pinpoint for some. There were days it came on so fast that I could not get out of my car when I got home, due to pain in my hand/wrist. It felt like critters were in the joints just chewing!

    Go to see a good doctor that will run a battery of tests to look for markers. I have to go for blood work each quarter and have damage on my upper hand, and under my toes on my left foot. If the doctor that you go to will not diagnose properly find another one!

    This is serious stuff and it hurts. I am almost pain free after 3 years, but still have stiffness each morning and do better if I move throughout the day.

    Blessings to one and all.

    Shar

  6. #6 Todd
    Maine
    December 21, 2013

    I was diagnosed parvo b19 virus almost 2 years ago and still deal with crippling pain in my hands and feet. I’m 42 and I’ve been to several RD’s and they can only speculate on exactly what is going on. I’ve tried immunosuppressant drugs and prednisone and the prednisone helps a bit but at large doses which cause their own problems. Life since parvo B19 infection has also been plagued with other joint and back pain as well as sleep and memory problems. Periodically I will get a rash around my nose and then a flare up in symptoms will follow. I’m really hoping more studies will be done so people suffering from post parvo virus symptoms will get their lives back.

  7. #7 Ronda
    Ga
    May 13, 2014

    I developed a rash back in November 2013, and was told I had the flu, RA, and Lupus even tho the test were negative. 3 doctors and a few hundred dollars later I tested positive for parvo. Thank God I can finally walk again and am trying to exercise but it takes a week for me to recover and now the joint and muscle stiffness has turned into frequent sharp pain. I have gained about 20 pounds and that makes it even harder to walk now. I don’t know what to do at this point. I have seen 2 more doctors since being diagnosed and they are clueless. The best advice they could think of was take ibuprofen and it should go away between 3 months and 9 years. I am 29 years old limping around here like I’m 70. I can’t drive long distances, can’t stay in the same spot for long, and have developed insomnia again because it hurts to sleep in the same spot all night.y hands and wrists are killing me. I only have a fewore semesters in school and am trying not to put it on hold but this is wearing me out. I just wish they had more knowledge on treating parvo. If anybody has any suggestions I am open to be the test dummy if it means getting better.