Parvovirus B19 infection has been associated with arthritis and arthralgias, most commonly in adults but also in children. Arthritic symptoms associated with Parvovirus B19 infection are more common in women than in men. Approximately 60% of women with symptomatic B19 infection have been reported to have arthritic symptoms. Arthritic symptoms typically include painful, swollen and stiff joints.

Reports suggest that B19 arthralgia may affect any joint but usually occurs in the wrist, hand, knee and ankle. Arthritic symptoms can last for 1-3 weeks but have been reported to last for months or years in approximately 20% of affected women. It has been suggested that B19 infection can cause arthritic symptoms similar to those found in Rheumatoid Arthritis and Juvenile Arthritis as evidence of recent infection and high antibody levels have been found in these patients. Diagnosis of B19 arthritis can be difficult as chronic Parvovirus B19 arthritis may be indistinguishable from classic RA, often fulfilling the American College of Rheumatism criteria for diagnosis of RA. Evidence suggesting that B19 infection may be involved in the pathogenesis of RA has been demonstrated in a number of studies.

• Takahashi et al detected B19 DNA in the synovial tissue in 30/39 patients with Rheumatoid Arthritis compared with 4/26 with Osteoarthritis. B19 VP1 was expressed in all 27 patients with RA that had active synovial lesions but not in patients with OA or controls.
• A recent report produced by Lehmann et al suggested a link between B19 infection and rheumatic disease of childhood. This work clearly showed a significant difference in serum and /or synovial fluid-derived B19 DNA between control (9/124, 7%) and patient (26/74, 35%) specimens and concluded that the rate of persistent B19 infection in these patients is notably higher than in age-matched controls.
  

It has been suggested that Parvovirus B19 infection is involved in the pathogenesis of a variety of rheumatic diseases, however, it is generally accepted that further work needs to be carried out in this area to establish a clearer understanding of how B19 is involved.

References

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2.  Human Parvovirus arthropathy. Lancet i, 1985: 419-421 White, D.G., Woolf, A.D., Mortimer, P.P., Cohen, B.J., Blake,D.R., Bacon, P.A.
   
3. Clinical manifestations of human Parvovirus B19 in adults. Arch Intern Med 1989: 149, 1153-1156Woolf, A.D., Campion, G.V.,Chishick, A., Wise, S., Cohen, B. J., Klouda, P.T., Caul, O., Dieppe, P.A.
   
4. Pathogenesis of human Parvovirus B19 in rheumatic disease. Ann Rheum Dis 2000; 59:672-683 Kerr, J.R.
   
5. Advances in the biology, diagnosis and host-pathogen interactions of Parvovirus B19 Journal of Medical Microbiology 2004:53, 459-475. Corcoran A., Doyle S.
   
6. Human parvovirus B19 as a causative agent for rheumatoid arthritis. Proc. Natl.Acad Sci.1998:95,8227-8232. Takahashi Y., Chihiro M., Shinobu S., Yasuhiko M., Tomonori I., Keiko I., Takako S., Takashi S., Kazuo S., Takeshi S.
   
7. Frequent infection with a viral pathogen, parvovirus B19, in rheumatic diseases of childhood. Arthritis Rheum 2003 48:1631-1638. Lehmann,H.W., Knöll, A., Küster, R.M., Modrow,