has recently gained attention as a potential treatment, this article
seems like it could have relevance for future studies.
-----------------------------------------------------------
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936947/?tool=3Dpubmed
Rheumatology (Oxford). 2010 Oct;49(10):1911-9. Epub 2010 Jun 14.
Epstein-Barr virus in bone marrow of rheumatoid arthritis patients
predicts response to rituximab treatment.
Magnusson M, Brisslert M, Zendjanchi K, Lindh M, Bokarewa MI.
SourceDepartment of Rheumatology and Inflammation Research,
Sahlgrenska University Hospital, Guldhedsgatan 10A, 413 46 G=C3=B6teborg,
Sweden. mattias.magnusson@rheuma.gu.se
Abstract
OBJECTIVES: Viruses may contribute to RA. This prompted us to monitor
viral load and response to anti-CD20 therapy in RA patients.
METHODS: Blood and bone marrow from 35 RA patients were analysed for
CMV, EBV, HSV-1, HSV-2, parvovirus B19 and polyomavirus using
real-time PCR before and 3 months after rituximab (RTX) treatment and
related to the levels of autoantibodies and B-cell depletion. Clinical
response to RTX was defined as decrease in the 28-joint disease
activity score (DAS-28) >1.3 at 6 months.
RESULTS: Before RTX treatment, EBV was identified in 15 out of 35
patients (EBV-positive group), of which 4 expressed parvovirus.
Parvovirus was further detected in eight patients (parvo-positive
group). Twelve patients were negative for the analysed viruses.
Following RTX, EBV was cleared, whereas parvovirus was unaffected.
Eighteen patients were responders, of which 12 were EBV positive. The
decrease in the DAS-28 was significantly higher in EBV-positive group
compared with parvo-positive group (P=E2=80=89=3D=E2=80=890.002) and virus-=
negative
patients (P=E2=80=89=3D=E2=80=890.04). Most of EBV-negative patients that r=
esponded to
RTX (75%) required retreatment within the following 11 months compared
with only 8% of responding EBV-positive patients. A decrease of RF,
Ig-producing cells and CD19(+) B cells was observed following RTX but
did not distinguish between viral infections. However, EBV-infected
patients had significantly higher levels of Fas-expressing B cells at
baseline as compared with EBV-negative groups.
CONCLUSIONS: EBV and parvovirus genomes are frequently found in bone
marrow of RA patients. The presence of EBV genome was associated with
a better clinical response to RTX. Thus, presence of EBV genome may
predict clinical response to RTX.
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