title: EBV reactivation serological profile in primary Sjögren's syndrome: an underlying trigger of active articular involvement?
abstract: Antibody to Epstein-Barr virus (EBV) early antigen diffuse (anti-EA-D) is associated with viral replication. However, their possible associations with clinical/therapeutic features in primary Sjögren's syndrome (pSS) were not established. We evaluated 100 pSS patients (American-European Criteria) and 89 age/gender/ethnicity-matched healthy controls. Disease activity was measured by EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI). Antibodies to EBV (anti-VCA IgG/IgM, anti-EBNA-1 IgG, anti-EA-D IgG) were determined by ELISA. Patients and controls had comparable frequencies and mean levels of anti-VCA IgG (90 vs. 86.5 %, p = 0.501; 2.6 ± 1.1 vs. 2.5 ± 1.1 AU/mL, p = 0.737) and anti-EBNA-1 IgG (92 vs. 94.4 %, p = 0.576; 141.3 ± 69.8 vs. 135.6 ± 67.5 RU/mL, p = 0.464). Anti-VCA IgM was negative in all cases. Noteworthy, higher frequency and increased mean levels of anti-EA-D were observed in patients than controls (36 vs. 4.5 %, p < 0.0001; 38.6 ± 57.4 vs. 7.9 ± 26.3 RU/mL, p < 0.0001). Further analysis of patients with (n = 36) and without (n = 64) anti-EA-D revealed comparable age/gender/ethnicity (p ≥ 0.551), current prednisone dose (4.8 ± 6.9 vs. 5.1 ± 10.4 mg/day, p = 0.319), and current uses of prednisone (52.8 vs. 37.5 %, p = 0.148) and immunosuppressants (44.4 vs. 31.3 %, p = 0.201). ESSDAI values were comparable (p = 0.102), but joint activity was more frequent (25 vs. 9.4 %, p = 0.045) in anti-EA-D positive patients. Anti-EA-D antibodies were not associated with anti-Ro/SSA (p = 1.000), anti-La/SSB (p = 0.652), rheumatoid factor (p = 1.000), anti-α-fodrin (p = 0.390) or antiphospholipid antibodies (p = 0.573), not suggesting cross-reactivity. The higher anti-EA-D frequency associated with joint activity raises the possibility that a subclinical EBV reactivation may trigger or perpetuate the articular involvement in pSS.
authors.affiliation: Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil. sandrapasoto@yahoo.com.br
authors.forename: Sandra Gofinet
authors.initials: SG
authors.lastname: Pasoto
authors.forename: Renato Romera
authors.initials: RR
authors.lastname: Natalino
authors.forename: Henrique Pires
authors.initials: HP
authors.lastname: Chakkour
authors.forename: Vilma Dos Santos Trindade
authors.initials: Vdos S
authors.lastname: Viana
authors.forename: Cleonice
authors.initials: C
authors.lastname: Bueno
authors.forename: Elaine Pires
authors.initials: EP
authors.lastname: Leon
authors.forename: Margarete Borges Gualhardo
authors.initials: MB
authors.lastname: Vendramini
authors.forename: Mauricio Levy
authors.initials: ML
authors.lastname: Neto
authors.forename: Eloisa
authors.initials: E
authors.lastname: Bonfa
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D000956:Antigens, Viral / Q000276:immunology*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007596:Joints / Q000187:drug effects / Q000276:immunology* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology*; D014775:Virus Activation
chemical_list: D000974:Antibodies, Antinuclear; D000914:Antibodies, Viral; D000956:Antigens, Viral; D015415:Biomarkers; C083204:Epstein-Barr virus early antigen diffuse component; D005938:Glucocorticoids; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D011241:Prednisone