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Parvovirus may link to rheumatoid arthritis
July 25, 2005 FAMILY DOCTOR Allen Douma, M.D. Tribune Media Services
Q: I’m approaching the one-year anniversary of a bout with a virus, which blood tests finally showed to be parvovirus B19. After 5 months of lingering symptoms, I was also “officially” diagnosed with rheumatoid arthritis.
I was the second of three women (that I know of) in a relatively isolated geographic area who were initially misdiagnosed. Our doctors thought it was most likely Lyme disease.
The rheumatologist put me on methotrexate. I am currently self-injecting Humira, which has definitely been more effective.
Is the incidence of Parvovirus B19 increasing? I’m also interested in the parvo/rheumatoid arthritis connection. Thanks for your help. I’ve learned a lot in reading your column. — P.F.
A: Studies have shown that as many as two-thirds of middle aged women have been infected with this virus, while other studies have found that as few as 20 percent of teenagers have had it. However, in my review of the medical literature I was unable to tell if the incidence of the parvovirus B19 is increasing.
For a long time, infection by parvovirus B19 has been associated most closely with erythema infectiosum (aka “fifth disease”). It occurs in young children, causing fiery red cheeks and a whitish circle around the mouth. This is followed by a rash on the trunk, malaise, headache and itching, but little fever.
Parvovirus B19 is also known to be associated with adverse effects on fetuses such as hydrops fetalis, aplastic anemia, and intrauterine fetal death. Recently this virus has shown up in tissue from inflamed hearts.
Before providing information about the possible connection between the parvovirus and rheumatoid arthritis (RA), I’ll provide information on RA.
As many as 5 million people in North America have rheumatoid arthritis. It usually starts before the age of 40 and affects three times as many women as men. But there are forms that can start in children.
RA is chronic inflammation that affects many tissues of the body but causes greater problems in the joints. A person’s immune system attacks and partially destroys cartilage, bone, ligaments and tendons.
Diagnosing rheumatoid arthritis depends on both the characteristic symptoms and medical tests. Joint stiffness is often preceded by malaise, fever and weight loss. Joint involvement typically begins in the fingers and toes, and works its way toward the shoulders and hips. This may happen very rapidly or take many years.
X-rays of rheumatic joints show thinning of the surrounding bone, erosion of the joint lining, and narrowing of the joint space. In addition, a blood test for rheumatoid factor is usually positive. But this test may be positive with other diseases as well.
RA is an autoimmune disease in which the immune system starts to attack and destroy specific cells in the body, especially those lining the joints. But the direct cause or causes that activate the immune system is unknown.
Symptoms of acute arthritis are also often present in adults who get infected with the parvovirus. And this virus is detected in the bloodstream in a higher percentage of those with rheumatic diseases like chronic arthritis. But since the virus has not been found in the joints themselves, it reinforces the autoimmune theory of RA. The evidence indicates that parvovirus is a strong suspect for at least one of the causes of RA.
Treating rheumatoid arthritis involves many components and requires active participation by the person. Although medications play an important role, other management activities are critical.
This begins with a thorough understanding of the disease, its treatment, and the physical and psychological impact it can have. To help minimize further damage, people with RA should rest and exercise the joints appropriately, lose weight if overweight, use heat and cold when indicated, and use splints judiciously.
More than 50 drugs, including aspirin, methotrexate and Humira have been shown to be effective. Start by using the least damaging (often less expensive) drugs. But if these are not effective, try one or more different drugs.
Write to Allen Douma in care of Tribune Media Services, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y. 14207; or contact him at
DRFamily@aol.com
E.B. family grateful for ongoing aid efforts
Monthly medical costs $18K after insurance for treatment of girl, 7
BY MARY ANNE ROSS
Correspondent
Tara Mee (r) talks with sister Vicky Olender as the two prepare for the June 24 yard sale to benefit a trust fund set up for Mee's daughter, Allison, 7, who is battling a blood disorder. At right: Allison Mee (c) with her brother, Kevin, and sister, Nicole.
EAST BRUNSWICK - Indulging in the simple joys of childhood can be life-threatening to 7-year-old Allison Mee.
Allison suffers from the rare blood disorder aplastic anemia. The condition prevents her bone marrow from producing new blood cells, which increases her risk for infections and hemorrhaging. Allison cannot go to school or play with her friends because her immune system cannot fight off the colds and viruses that spread so easily among children. A fall from her bike or a swing in the park can produce uncontrolled bleeding and even a dip in the swimming pool might expose her to bacteria that could lead to infections.
Allison was diagnosed last November when she was 6.
"I noticed that she had so many bruises and she really couldn't explain them," recalled her mother, Tara. "I didn't know what to make of it. She even had bruises on her eyelids. One day she came home with large wide bruises on the back of her knees just from being hit by the swing. She also had a horrific nose bleed one night. I knew something was wrong."
Tara brought Allison to her pediatrician, who immediately placed her in the hospital. For five days the doctors did blood work, trying to rule out cancer, leukemia, viruses and other disorders. Finally the tests revealed that Allison was suffering from a severe form of aplastic anemia.
The condition is curable. Treatments include blood transfers, medications and sometimes bone marrow transplants.
"They try to treat it with medication first," Tara noted, "because the preparation for bone marrow transplant is so extreme and has so many side effects."
Two to three times a week, Allison and her mother go to the clinic at Saint Peter's University Hospital in New Brunswick to have her blood tested. If her blood cell counts are not good, Allison may need transfusions, which can take most of the day, or she may need to be hospitalized.
"I never know when I bring her in the morning if we will be there for an hour or all day or be spending the night in the hospital," Tara said. She estimated that they have had 63 overnights in the hospital and another 53 full days on an outpatient basis.
Allison was recently scheduled for a bone marrow transplant, but the operation was postponed when her blood work began to improve. That trend is continuing, and they may not need the operation.
Tara and her husband, Mike, have two other children to care for besides Allison. Nicole is 5 and Kevin is 2.
"I have three sisters who have really pitched in," Tara noted. "My friends and neighbors have been amazing, so have my parents and in-laws. Someone is always willing to help me out with the younger ones. It's just wonderful how supportive everyone has been."
One of the ways people have been supportive of the Mee family is through fundraising efforts. Tara estimated that, after insurance, the family is faced with more than $18,000 in medical bills each month for Allison's care.
Her sister, Vicki Olender, has arranged several fundraisers for the family. Olender is president of the Lawrence Brook School PTA, where Allison attended first grade before she became ill. Olender noted that "different organizations from the community have really worked together" to help out in recent months.
A blood drive was held in March at Lawrence Brook, and more than 100 pints of blood were donated. Girl Scout troops provided juice and cookies. The Lawrence Brook School Early Act Club offered baby-sitting, and the Brancato family, who own Mimi's Ices, donated ices to all the volunteers and donors. In May, family friend Helaine Balsamo had a Pampered Chef party, and there was also a Baja Fresh fundraiser.
Most recently, a yard sale was held, with all the sale items donated by various people. Mimi's Ices again donated its services, and Sayreville Seafood donated subs to feed the volunteers.
"Even though it rained, we had a tremendous turnout. We raised $3,000," Olender said.
Allison's grandparents Diane and Charlie Aboussleman, of Staten Island, N.Y., also arranged a comedy night dinner at their local Knights of Columbus and raised around $12,000.
Several fundraisers are being planned for the fall, including a children's play performed by Michael Taubenslaug Productions, a spaghetti dinner at the Knights of Columbus, and an event at the Stress Factory in New Brunswick. The family is hoping the community will continue to come out and support the events and perhaps donate baskets, gift cards and other items to raffle off. They also wish to express their appreciation to everyone who has helped and continues to support the family.
"We have received unbelievable support from family and friends," Olender said. "They know who they are and we thank them from the bottom of our hearts. We couldn't do it without their help."
Donations can be mailed at any time to The Allison Mee Fund at 4 Mitchell Ave., East Brunswick 08816. This is a nonprofit fund set up to help pay for Allison's medical bills.
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