Epstein-Barr virus, arthritis, and the development of lymphoma in arthritis patients

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Curr Opin Rheumatol. 2004 Jul;16(4):399-405.

Epstein-Barr virus, arthritis, and the development of lymphoma in

arthritis patients.

Callan MF.

Department of Immunology, Division of Medicine, Imperial College,

London, UK. m.callan@...

PURPOSE OF REVIEW: Rheumatoid arthritis is a complex multisystem

disorder. The manifestations of joint disease are usually clinically

apparent, but the effects of the concomitant abnormalities of immune

function are more subtle. It has been suggested that patients with

rheumatoid arthritis have an impaired capacity to control infection with

Epstein-Barr virus. Epstein-Barr virus has oncogenic potential and is

implicated in the development of some lymphomas. This review analyses

the relation between Epstein-Barr virus, rheumatoid arthritis, and the

risk of lymphoma and considers the effect of immunosuppression on this

triad. RECENT FINDINGS: Recent publications provide evidence for an

altered Epstein-Barr virus-host balance in patients with rheumatoid

arthritis, who have a relatively high Epstein-Barr virus load. Large

epidemiologic studies confirm that lymphoma is more likely to develop in

patients with rheumatoid arthritis than in the general population. The

overall risk of development of lymphoma has not risen with the increased

use of methotrexate or biologic agents. Histologic analysis reveals that

most lymphomas in rheumatoid arthritis patients are diffuse large B cell

lymphomas, a form of non-Hodgkin lymphoma. Epstein-Barr virus is

detected in a proportion of these.

SUMMARY: Overall, patients with rheumatoid arthritis have approximately

a twofold increased risk of experiencing lymphoma. Some, but not all, of

this increased risk reflects an increase in Epstein-virus-associated

lymphomas. This in turn may be influenced by the elevated Epstein-Barr

virus load found in rheumatoid arthritis patients and may reflect subtle

impairment of antiviral immunity in this group of patients.

PMID: 15201603

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