title: Antiphospholipid antibodies in pediatric and adult patients with rheumatic disease are associated with parvovirus B19 infection.
abstract: OBJECTIVE
  To show a possible association between parvovirus B19 infection and the presence of antiphospholipid antibodies (aPL) in patients with rheumatic diseases.
  
  
  METHODS
  Serum samples obtained from 88 children with various forms of juvenile rheumatic disease and from 40 adults with systemic lupus erythematosus, the antiphospholipid syndrome, or other rheumatic disease, who had previously been tested and shown to be positive for IgG aPL, were analyzed for the presence of B19 DNA, for antibodies against the B19 viral proteins VP1, VP2, and NS1, and for IgG aPL (anticardiolipin, anti-beta(2)-glycoprotein I, and antiphosphatidylserine). As controls, serum samples obtained from 135 children with noninflammatory bone diseases or growth retardation were also analyzed.
  
  
  RESULTS
  Twenty-four (27%) of the 88 children with rheumatic diseases had detectable amounts of IgG aPL. Fourteen (58%) of these 24 IgG aPL-positive patients showed IgG against VP1/VP2 and viral genomes, indicating the presence of acute (2 patients) or persistent (12 patients) infection. Past parvovirus B19 infection was identified in 7 (29%) of 24 IgG aPL-positive children, as indicated by VP1/VP2-specific IgG in the absence of viral DNA. Three (12%) of 24 IgG aPL-positive children had not been infected with B19. Sixty-nine (51%) of 135 control children displayed VP1/VP2-specific IgG. Three (2%) of these 135 children were IgG aPL positive (2 children had past parvovirus B19 infection, and 1 was negative for parvovirus B19). Analysis of the parvovirus B19 status of 40 adult IgG aPL-positive patients showed that 33 (83%) were anti-IgG VP1/VP2-positive, and viral DNA was detected in 11 patients (28%). Ten of these 11 viremic patients were in the subgroup of 28 IgG aPL-positive SLE patients.
  
  
  CONCLUSIONS
  Antiphospholipid antibodies are preferentially found in serum of children with juvenile idiopathic arthritis who have been previously infected with parvovirus B19 and have established, persistent infection. Adult patients with IgG aPL positivity have a high incidence of persistent parvovirus B19 infection. We conclude that parvovirus B19 might be directly involved in the elicitation of autoimmune reactions partly mediated by aPL.
authors.affiliation: Klinik and Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Regensburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Von Landenberg
authors.forename: Hartwig W
authors.initials: HW
authors.lastname: Lehmann
authors.forename: Antje
authors.initials: A
authors.lastname: Knöll
authors.forename: Simone
authors.initials: S
authors.lastname: Dorsch
authors.forename: Susanne
authors.initials: S
authors.lastname: Modrow
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D000914:Antibodies, Viral / Q000097:blood; D001323:Autoantibodies / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D010322:Parvoviridae Infections / Q000453:epidemiology / Q000276:immunology*; D016732:Parvovirus B19, Human / Q000235:genetics / Q000276:immunology*; D012216:Rheumatic Diseases / Q000453:epidemiology / Q000276:immunology* / Q000821:virology*; D016036:Seroepidemiologic Studies
chemical_list: D017152:Antibodies, Antiphospholipid; D000914:Antibodies, Viral; D001323:Autoantibodies; D004279:DNA, Viral; D007074:Immunoglobulin G