Balandraud Nathalie, Guis Sandrine, Meynard Jean Baptiste, Auger Isabelle, Roudier Jean, Roudier Chantal
INSERM Unité 639, Marseille, France.
Arthritis Rheum. 2007 Jun 15;57(5):762-7. doi: 10.1002/art.22783.
We previously demonstrated that patients with rheumatoid arthritis (RA) have a 10-fold systemic Epstein-Barr virus (EBV) overload, very similar to that observed in healthy organ transplant recipients. Our objective was to monitor EBV load over time in patients with RA receiving methotrexate, infliximab, or etanercept to detect possible immunosuppression-associated EBV dysregulation, as described in posttransplant lymphoproliferative disease.
The EBV load in the peripheral blood mononuclear cells (PBMCs) from 19 patients receiving methotrexate, 68 patients receiving infliximab, and 48 patients receiving etanercept was monitored for durations ranging from 6 months to 5 years using a real-time polymerase chain reaction assay previously developed for that purpose. The effect of treatment duration on EBV load and the link between the Disease Activity Score in 28 joints and EBV load were analyzed by generalized estimating equations.
Methotrexate tended to decrease EBV load over time, but this did not reach significance. Tumor necrosis factor alpha (TNFalpha) inhibitors did not significantly modify EBV load over time. Finally, high disease activity was significantly associated with high EBV load.
Long-term usage of methotrexate or TNFalpha inhibitors in patients with RA does not significantly influence EBV load in PBMCs.
我们之前证明类风湿关节炎（RA）患者存在10倍的全身性EB病毒（EBV）过载，这与在健康器官移植受者中观察到的情况非常相似。我们的目的是监测接受甲氨蝶呤、英夫利昔单抗或依那西普治疗的RA患者随时间推移的EBV载量，以检测如移植后淋巴细胞增殖性疾病中所描述的可能与免疫抑制相关的EBV失调。
使用此前为此目的开发的实时聚合酶链反应检测法，对19例接受甲氨蝶呤治疗的患者、68例接受英夫利昔单抗治疗的患者和48例接受依那西普治疗的患者的外周血单个核细胞（PBMC）中的EBV载量进行了6个月至5年的监测。通过广义估计方程分析治疗持续时间对EBV载量的影响以及28个关节疾病活动评分与EBV载量之间的联系。
随着时间推移，甲氨蝶呤倾向于降低EBV载量，但未达到显著水平。肿瘤坏死因子α（TNFα）抑制剂并未随时间显著改变EBV载量。最后，高疾病活动度与高EBV载量显著相关。
RA患者长期使用甲氨蝶呤或TNFα抑制剂对PBMC中的EBV载量没有显著影响。
