Data implicate various viral exposures in the etiology of rheumatoid arthritis (RA). To assess evidence relating to the association between putative viral exposures and the development of RA, Janet Elizabeth Pope, MD, MPH, FRCPC, and colleagues conducted a systematic review, published in Seminars in Arthritis and Rheumatism. “It could be an important public health concern if several viruses were found to cause RA, a costly chronic disease affecting approximately 1% of adults,” says Dr. Pope

For the study, the researchers reviewed more than 6,700 case–controls, cross-sectional or cohort studies. Overall, they found human parvovirus B19, or PBV19, infection rates to be increased in patients with RA when compared with controls. While Immunoglobulin G anti-Epstein-Barr nuclear antigen antibodies were not increased in those with RA, anti-viral capsid antigen and anti-early antigen antibodies were increased in this population. And although cytomegalovirus and hepatitis B virus were not associated with RA, hepatitis C virus was associated with RA in seven case–control studies and one cohort study.

“There are very few viruses studied that caused RA, and the risk associated with them was not generally high,” says Dr. Pope. “With common viral exposures rarely causing RA, public health campaigns to prevent these infections solely to reduce RA risk would be misguided; however vaccination for common viral illnesses is beneficial for overall health, including slightly decreasing autoimmunity. Studies assessing the causes of common autoimmune diseases may provide needed insight and could lead to other prevention strategies. For instance, some labs are studying a vaccination to prevent development of RA in high-risk patients, but these strategies are not ready for public use.”


A systematic review of viral exposures as a risk for rheumatoid arthritis