Can Parvovirus B19 Infection Cause Lupus & Does It Cause Joint Pain?

Approximately 25% of parvovirus B19 infections are asymptomatic.(1)

Arthropathy associated with B19 infection is more common in females than in males.(2)

Can Parvovirus B19 Infection Cause Lupus?

Although parvovirus B19 infection does not cause lupus, it may mimic the clinical presentation of systemic lupus erythematosus and confuse the clinicians into reaching a correct diagnosis. Parvovirus B19 infection is associated with a transient autoimmune state that with serological and PCR testing shows the presence of autoantibodies, in about 25-68% of the cases. The antibodies present include rheumatoid factor, antinuclear antibodies, phospholipids, and antibodies to double-stranded DNA, Sjogren’s syndrome antigens A and B, and ribonucleoprotein. The resolution usually takes place within 3 months of the infection.(1)

Clinically, acute parvovirus B19 infection can also be distinguished from systemic lupus erythematosus as the distinct feature of SLE that includes the malar rash involving the nose is absent in parvovirus B19 infection. Other distinguishing features of B19 infection include mild symptoms, and absence of alopecia, discoid lesions, and Raynaud’s phenomenon. The involvement of the heart, kidneys, GI tract, spleen, brain, eyes, and persistence of fever is rare in B19 infection. Anemia associated with parvovirus B19 infection is due to bone marrow suppression; whereas, in lupus, it is due to autoimmune hemolysis. The reticulocyte count is low in B19 infection; whereas normal to high in lupus. Mainly, the course of B19 infection is self-limiting whereas lupus is a chronic disease and symptoms persist throughout life.(1)

Does Parvovirus B19 Cause Joint Pain?

Generally, parvovirus B19 infection is asymptomatic in around 25% cases. The manifestations of symptomatic infections include erythema infectiosum (fifth disease), arthropathy (joint disease), transient aplastic crisis (TAC), bone marrow failure, and fetal disease (in pregnant women).(1)

The most common presentation of parvovirus B19 infection is erythema infectiosum, which is mostly seen in children. It is associated with prodromal symptoms of fever, nausea, malaise, cold, headache, and muscle pain. It is followed by a red macular or maculopapular rash on the cheeks with associated circumoral pallor. The ‘slapped cheek’ appearance of the rash is commonly seen in children. The rash may be itchy and can spread to the trunk and lower body. The rash may recur or exacerbate due to sun exposure, stress, or exercise. This rash is usually self-limiting and subsides on its own.(2)

In adults, this rash is associated with polyarthropathy syndrome in which they develop acute symmetric arthritis that affects small joints. Women are more commonly affected (about 60%) than men (about 30%). The most commonly affected joints include joints of the hands, knees, wrists, feet, and ankles. Arthropathy may include pain and/or swelling in the joints that are usually symmetrical. However, unlike rheumatoid arthritis, arthropathy associated with parvovirus B19 infection is not associated with erosion of the joints and is not chronic. In most cases, there is a complete resolution of the joint disease in a few weeks.(1),(2)

Although parvovirus B19 infection is non-threatening for healthy individuals, it may become life-threatening for immunocompromised patients and fetal infection during pregnancy. Patients with blood disorders and high red blood cell turnover may experience a transient aplastic crisis.

Immunocompromised patients may suffer from red cell aplasia and bone marrow suppression. Maternal infection may lead to hydrops fetalis or intrauterine fetal death. The mortality associated with fetal infection is around 15% before week 20 of gestation.(1)

Parvovirus B19 Infection

Parvovirus B19 is a single-stranded DNA virus belonging to the family Parvoviridae. It is the first-ever known virus in its family to infect humans. It is an extremely common infection worldwide. In older adults, the antibody seropositivity rate reaches 90% from 5-10% in children of 2-5 years of age. The infection is more common in school going children and is transmitted to the family via them. The infection is seasonal with a peak in late winters and early spring. The transmission is mainly via respiratory droplets, mother to child, and blood and blood products. In healthy individual’s parvovirus B19 is associated with an extremely low mortality rate.(1),(2)

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