Previous Epstein-Barr virus (EBV) infection is associated with increased disease activity and impaired response to treatment in children with juvenile idiopathic arthritis (JIA), a recent study has found.
The study, “The Impact of Epstein-Barr Virus Infection on Juvenile Idiopathic Arthritis Activity and Patient’s Response to Treatment,” was published in the Journal of Clinical Medicine.
JIA is treated with a variety of pharmacological medications, which are not effective in all patients. Understanding the genetic and environmental factors underlying JIA development may help improve treatment options for the disorder.
Researchers at the Medical University of Lublin in Poland hypothesized that EBV, a virus that causes the mononucleosis infection that is common in children and adolescents, may influence JIA development. As such, their study assessed the potential relationship between EBV and JIA onset, progression, and response to treatment.
Participants in the study were 44 newly-diagnosed children with JIA — with a median age of 8 and 70% female — 23 children with different arthritis types (median age of 13 and 61% female), along with 44 healthy people (controls).
The scientists assessed disease activity using the Juvenile Arthritis Disease Activity Score 71 (JADAS 71), and response to treatment at three and six months using the American College of Rheumatology Pediatric response criteria (PedACR). The PedACR includes a physician-reported assessment of disease activity, a parent/patient assessment of overall well-being, as well as analyses of functional ability, inflammation, number of joints with active arthritis, and number of joints with limited range of motion.
JIA patients were treated with the disease-modifying antirheumatic drugs (DMARDs) methotrexate, sulfasalazine, or both, for the six months after diagnosis and during a six-month follow-up period. Methotrexate was administered as a once-weekly oral or subcutaneous (under the skin) dose of 10–15 mg per square meter. The dose and route of treatment were modified by the patient’s physician, based on patient tolerance of the treatment and disease activity.
Results showed that children who had a previous EBV infection, determined by the presence of antibodies against the virus, had significantly higher disease activity six months after diagnosis compared to children without previous infection. Also, JIA patients with past EBV infection were 6.5 times more likely to exhibit disease activity six months into treatment.
Because EBV infection affected disease activity during treatment, the researchers compared children with and without previous infection to assess their treatment outcomes. Past EBV infection had a significantly negative impact on response to treatment. In fact, participants with past infections were more than five times more likely to have a poor response to treatment than those without past infection.
Notably, although EBV infection appears to affect JIA disease activity and treatment outcomes, no association was identified between past EBV infections and the onset of JIA or other types of arthritis, as assessed by comparing blood concentrations of anti-EBV antibodies and the proportion of children with EBV across the different groups.
“Our study showed that past EBV infection in JIA patients may be associated with higher disease activity and poorer response to treatment during the first six months of the disease,” the investigators wrote.
However, “our results do not indicate the need for routine assessment of EBV infection markers in patients with JIA. The examination should be recommended in case of persistent disease activity or lack of an expected response to treatment,” they added.
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