title: Is routine viral screening useful in patients with recent-onset polyarthritis of a duration of at least 6 weeks? Results from a nationwide longitudinal prospective cohort study.
abstract: OBJECTIVE
  To study the contribution of routine viral screening tests in patients with early rheumatoid arthritis (RA) or a potential for progressing to RA.
  
  
  METHODS
  Eight hundred thirteen patients with swelling of at least 2 joints for at least 6 weeks and a symptom duration of less than 6 months in the ESPOIR cohort were screened for parvovirus B19 (IgG and IgM anti-parvovirus B19 antibodies), hepatitis B virus (HBV; hepatitis B surface antigen), hepatitis C virus (HCV; anti-HCV antibodies), and human immunodeficiency virus (HIV; anti-HIV-1 and -2 antibodies).
  
  
  RESULTS
  Parvovirus B19 testing was performed in 806 patients and showed longstanding immunity in 574 (71.2%) and no antibodies in 223 (27.7%). Among the 9 remaining patients (7 IgG positive/IgM positive, 1 IgG negative/IgM positive, and 1 IgG indeterminate/IgM positive), only 2 (0.25%; 95% confidence interval [95% CI] 0-0.99%) had a positive polymerase chain reaction test for parvovirus B19; these patients (women ages 34 and 40 years) had no extraarticular signs. HIV seroprevalence was 0.12% (n = 1 of 813; 95% CI 0.01-0.8%) and HCV seroprevalence was 0.86% (n = 7 of 808, 95% CI 0.38-1.86%). HCV-related arthritis was diagnosed in 4 patients (0.5%). HCV-seropositive patients had significantly higher transaminase levels than the other patients (P = 0.001), with no significant differences for the other laboratory data. HBV seroprevalence was 0.12% (n = 1 of 808; 95% CI 0.01-0.8%); the positive HBV status was known before study inclusion, and the patient had no diagnosis of HBV-related arthritis. Finally, routine viral testing identified 2 patients with parvovirus B19 infection and 3 with HBV infection (0.6%; 95% CI 0.2-1.5%). Cost was €85.05 per patient (total €68,720).
  
  
  CONCLUSIONS
  Routine serologic testing did not contribute substantially to the diagnosis in this context.
authors.affiliation: Brest Teaching Hospitals and Université Bretagne Occidentale, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Varache
authors.forename: Valérie
authors.initials: V
authors.lastname: Narbonne
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jousse-Joulin
authors.forename: Xavier
authors.initials: X
authors.lastname: Guennoc
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Daurès
authors.forename: Valerie
authors.initials: V
authors.lastname: Devauchelle-Pensec
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D001168:Arthritis / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005602:France / Q000453:epidemiology; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis / Q000276:immunology; D015528:HIV Seroprevalence; D015497:HIV-1 / Q000276:immunology; D015498:HIV-2 / Q000276:immunology; D006509:Hepatitis B / Q000175:diagnosis / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D006526:Hepatitis C / Q000175:diagnosis / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010322:Parvoviridae Infections / Q000175:diagnosis; D016732:Parvovirus B19, Human / Q000235:genetics / Q000276:immunology; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D012698:Serologic Tests; D014777:Virus Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000821:virology
chemical_list: D000914:Antibodies, Viral; D015415:Biomarkers; D004279:DNA, Viral; D015483:HIV Antibodies; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies