EBV reactivation serological profile in primary Sjögren’s syndrome: an underlying trigger of active articular involvement?

• Published in: Rheumatology international Vol. 33; no. 5; pp. 1149 - 1157
• Main Authors: Pasoto, Sandra Gofinet, Natalino, Renato Romera, Chakkour, Henrique Pires, Viana, Vilma dos Santos Trindade, Bueno, Cleonice, Leon, Elaine Pires, Vendramini, Margarete Borges Gualhardo, Neto, Mauricio Levy, Bonfa, Eloisa
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.05.2013; Springer Nature B.V
• Subjects: Adult; Antibodies, Antinuclear - blood; Antibodies, Viral - blood; Antigens, Viral - immunology; Biomarkers - blood; Case-Control Studies; Chi-Square Distribution; Disease Progression; Enzyme-Linked Immunosorbent Assay; Female; Glucocorticoids - therapeutic use; Herpesvirus 4, Human - immunology; Humans; Immunoglobulin G - blood; Immunoglobulin M - blood; Immunosuppressive Agents - therapeutic use; Joints - drug effects; Joints - immunology; Joints - virology; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Prednisone - therapeutic use; Rheumatology; Risk Factors; Severity of Illness Index; Sjogren's Syndrome - blood; Sjogren's Syndrome - diagnosis; Sjogren's Syndrome - drug therapy; Sjogren's Syndrome - immunology; Sjogren's Syndrome - virology; Virus Activation; Human T leukemia virus 1; EBV early antigen diffuse; Primary Sjögren’s syndrome; Epstein–Barr virus; Anti-EBV early antigen diffuse
• ISSN: 0172-8172; 1437-160X
• DOI: 10.1007/s00296-012-2504-3

Antibody to Epstein–Barr virus (EBV) early antigen diffuse (anti-EA-D) is associated with viral replication. However, their possible associations with clinical/therapeutic features in primary Sjögren’s syndrome (pSS) were not established. We evaluated 100 pSS patients (American–European Criteria) and 89 age/gender/ethnicity-matched healthy controls. Disease activity was measured by EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI). Antibodies to EBV (anti-VCA IgG/IgM, anti-EBNA-1 IgG, anti-EA-D IgG) were determined by ELISA. Patients and controls had comparable frequencies and mean levels of anti-VCA IgG (90 vs. 86.5 %, p  = 0.501; 2.6 ± 1.1 vs. 2.5 ± 1.1 AU/mL, p  = 0.737) and anti-EBNA-1 IgG (92 vs. 94.4 %, p  = 0.576; 141.3 ± 69.8 vs. 135.6 ± 67.5 RU/mL, p  = 0.464). Anti-VCA IgM was negative in all cases. Noteworthy, higher frequency and increased mean levels of anti-EA-D were observed in patients than controls (36 vs. 4.5 %, p  < 0.0001; 38.6 ± 57.4 vs. 7.9 ± 26.3 RU/mL, p  < 0.0001). Further analysis of patients with ( n  = 36) and without ( n  = 64) anti-EA-D revealed comparable age/gender/ethnicity ( p  ≥ 0.551), current prednisone dose (4.8 ± 6.9 vs. 5.1 ± 10.4 mg/day, p  = 0.319), and current uses of prednisone (52.8 vs. 37.5 %, p  = 0.148) and immunosuppressants (44.4 vs. 31.3 %, p  = 0.201). ESSDAI values were comparable ( p  = 0.102), but joint activity was more frequent (25 vs. 9.4 %, p  = 0.045) in anti-EA-D positive patients. Anti-EA-D antibodies were not associated with anti-Ro/SSA ( p  = 1.000), anti-La/SSB ( p  = 0.652), rheumatoid factor ( p  = 1.000), anti-α-fodrin ( p  = 0.390) or antiphospholipid antibodies ( p  = 0.573), not suggesting cross-reactivity. The higher anti-EA-D frequency associated with joint activity raises the possibility that a subclinical EBV reactivation may trigger or perpetuate the articular involvement in pSS.