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a Institute of
Clinical Immunology and Transfusion Medicine, University of Leipzig,
Leipzig, Germany, b Institute of Anatomy, University of Leipzig, c Institute of Virology,
University of Leipzig, d Department
of Rheumatology, Leiden University Medical Centre, Leiden, The
Netherlands, e Research
Laboratory for Infectious Diseases, National Institute of Public Health
and the Environment (RIVM), Bilthoven, The Netherlands, f Division of Clinical Immunology and
Rheumatology, Department of Internal Medicine, Academic Medical Centre,
Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands
Correspondence to: Professor Tak Email: P.P.Tak{at}amc.uva.nL
Accepted for publication 5 January 2000
OBJECTIVE
Viruses have
a role in the pathogenesis of various forms of arthritis. This study
aimed at determining whether viral DNA can be detected in joint samples
in the early stages of idiopathic arthritides.
METHODSSynovial fluid
(SF) and synovial tissue (ST) samples were obtained from 73 patients,
with undifferentiated arthritis (n=22), rheumatoid arthritis (n=13),
spondyloarthropathy (n=17), crystal arthropathy (n=8), osteoarthritis
(n=7), septic arthritis (n=5), and trauma (n=1). The presence of viral
DNA was investigated by polymerase chain reaction analysis.
RESULTSCytomegalovirus
was present in 25 patients, parvovirus B19 in 15 patients, Epstein-Barr
virus in 12 patients, and herpes simplex virus in 16 patients (in ST,
SF, or both), respectively. The joint samples were negative for viral
DNA from adenovirus and varicella-zoster virus. In ST, eight patients
were double positive for parvovirus B19 and another viral DNA,
with herpes simplex virus being the most
prevalent. Seven patients were double positive for other viruses
(cytomegalovirus, herpes simplex virus, Epstein-Barr virus). In SF,
four patients were double or triple positive for viral DNA. Paired
samples were available in 56 patients. In these, viral DNA was detected
in 37 patients in ST, as compared with 19 in SF.
CONCLUSIONThese data
show that one or more viruses can be detected in the synovial specimens
of patients with early arthritis, irrespective of the clinical
diagnosis. This observation might be explained by migration of
inflammatory cells harbouring viral DNA into the inflamed joints.
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