The  Epstein–Barr Virus and Rheumatoid Arthritis in Cancer Patients Undergoing Chemotherapy in Al-Najaf Province, Iraq

Rana  Talib Al-Nafakh; Faten  Abed AL-Kadhem Khalaf Aldawmy; Hawraa  Ameer Mubark; Shaymaa  Abdul Lateef Al-Fadhul; Heyder  Ibraheem Abdulrazzaq; Fatin  Naji Atyaa; Nouf  Jabbar Yasir; Saif  Jabbar Yasir

Rana Talib Al-Nafakh Department of Medical Microbiology, Faculty of Medicine, University of Kufa, Najaf, Iraq.
Faten Abed AL-Kadhem Khalaf Aldawmy Faculty of Pharmacy, University of Alzahraa, Karbala, Iraq.
Hawraa Ameer Mubark Department of Medical Microbiology, Faculty of Medicine, University of Kufa, Najaf, Iraq.
Shaymaa Abdul Lateef Al-Fadhul Department of Medical Microbiology, Faculty of Medicine, University of Kufa, Najaf, Iraq.
Heyder Ibraheem Abdulrazzaq Department of Medical Microbiology, Faculty of Medicine, University of Kufa, Najaf, Iraq.
Fatin Naji Atyaa Department of Medical Microbiology, Faculty of Medicine, University of Kufa, Najaf, Iraq.
Nouf Jabbar Yasir Department of Medical Microbiology, Faculty of Medicine, University of Kufa, Najaf, Iraq.
Saif Jabbar Yasir Department of Medical Microbiology, Faculty of Medicine, University of Kufa, Najaf, Iraq.

Keywords: EBV, RA, cancer patients, chemotherapy, ELlSA, IgM, and IgG

Abstract

Background: Some studies suggested a link between Epstein–Barr Virus (EBV) and rheumatoid arthritis, although the exact mechanism of this is not yet established. Cancer patients undergoing chemotherapy are
more immunocompromised. Hence this study has demonstrated the role of EBV in rheumatoid arthritis in these patients.
Objective: To study the relationship between Epstein–Bar viral infection and rheumatoid arthritis in cancer patients undergoing chemotherapy Patients and Methods: A cross-sectional study was conducted from September 1, 2021 to March 1, 2022. The study participants included 200 cancer patients who reported to the Middle Euphrates Cancer Center in Al Najaf for chemotherapy treatment. Cancer patients were diagnosed with cases of rheumatoid arthritis, according to rheumatologist physicians and serological tests. Five ml of blood was collected from every cancer patient. Each sample was screened for the presence of anti-EBV antibodies. The chi-square test was used to test the significance of the relationship between qualitative variables. A p value of less than or equal to 0.05 indicated a statistically significant difference.
Results: Two hundred cancer patients were included in this study. Their age ranged from 17 to 73 years. Nearly half of them (47.5%) aged 30–50 years. Most of them were females (67.0%) and 60.5% of the participants lived in urban areas. More than one-third of participants (40.0%) had rheumatoid arthritis. More than half of them (53.0%) were EBV-positive. Statistical analysis showed a highly significant association between EBV and rheumatoid arthritis (p < 0.00001). No significant differences (p > 0.05) were found between different age groups regarding anti-EBV-IgM and IgG antibodies in rheumatoid and non-rheumatoid patients. On the other hand, PCR testing showed a statistically significant difference (p < 0.001) in non-rheumatoid patients and no significant difference in rheumatoid patients.
Conclusion: A significant association was detected between EBV and rheumatoid arthritis in cancer patients treated by chemotherapy and this association was not related to EBV antibody levels.

How to cite this article:
Al-Nafakh RT, Aldawmy FAAK, Mubark HA, Al- Fadhul SAL, Abdulrazzaq HI, Almealawy YF, Atyaa FN, Yasir NJ, Yasir SJ. Epstein–Barr Virus and Rheumatoid Arthritis in Cancer Patients Undergoing Chemotherapy in Al-Najaf Province, Iraq. J Commun Dis. 2023;55(4):119-125.

DOI: https://doi.org/10.24321/0019.5138.202364

References

Zanella MC, Cordey S, Kaiser L. Beyond cytomegalovirus and Epstein-Barr Virus: a review of viruses composing

the blood virome of solid organ transplant and hematopoietic stem cell transplant recipients. Clin

Microbiol Rev. 2020;33(4):e00027-20. [PubMed] [Google Scholar]

Sternbæk L, Draborg AH, Østerlund MT, Iversen LV, Roelsen L, Theander E, Nielsen CT, Jacobsen S, Houen

G. Increased antibody levels to stage-specific Epstein– Barr virus antigens in systemic autoimmune diseases

reveal a common pathology. Scand J Clin Lab Investig. 2019;79(1-2):7-16. [PubMed] [Google Scholar]

Dunmire SK, Verghese PS, Balfour Jr HH. Primary Epstein-Barr virus infection. J Clin Virol. 2018;102:84-

[PubMed] [Google Scholar]

Thorley-Lawson DA. EBV persistence—introducing the virus. Curr Top Microbiol Immunol. 2015;390(Pt

:151-209. [PubMed] [Google Scholar]

Odumade OA, Hogquist KA, Balfour HH Jr. Progress

and problems in understanding and managing primary

Epstein-Barr virus infections. Clin Microbiol Rev.

;24(1):193-209. [PubMed] [Google Scholar]

Hsiao FC, Tai AK, Deglon A, Sutkowski N, Longnecker R,

Huber BT. EBV LMP-2A employs a novel mechanism to

transactivate the HERV-K18 superantigen through its

ITAM. Virology. 2009;385(1):261-6. [PubMed] [Google

Scholar]

Bullock J, Rizvi SA, Saleh AM, Ahmed SS, Do DP, Ansari

RA, Ahmed J. Rheumatoid arthritis: a brief overview

of the treatment. Med Princ Pract. 2018;27(6):501-

[PubMed] [Google Scholar]

Trier NH, Holm BE, Heiden J, Slot O, Locht H, Lindegaard

H, Svendsen A, Nielsen CT, Jacobsen S, Theander E,

Houen G. Antibodies to a strain-specific citrullinated Epstein-Barr virus peptide diagnoses rheumatoid arthritis. Sci Rep. 2018;8(1):3684. [PubMed] [Google Scholar]

Lossius A, Johansen JN, Torkildsen O, Vartdal F, Holmoy T. Epstein-Barr virus in systemic lupus erythematosus,

rheumatoid arthritis and multiple sclerosis-association and causation. Viruses. 2012;4(12):3701-30. [PubMed]

[Google Scholar]

Humphreys JH, Verstappen SM, Hyrich KL, Chipping JR, Marshall T, Symmons DP. The incidence of rheumatoid arthritis in the UK: comparisons using the 2010 ACR/EULAR classification criteria and the 1987 ACR classification criteria. Results from the Norfolk Arthritis Register. Ann Rheum Dis. 2013;72(8):1315-20. [PubMed] [Google Scholar]

Hatton OL, Harris-Arnold A, Schaffert S, Krams SM, Martinez OM. The interplay between Epstein-Barr virus and B lymphocytes: implications for infection, immunity, and disease. Immunol Res. 2014;58(2- 3):268-76. [PubMed] [Google Scholar]

Hjalgrim H, Friborg J, Melbye M. The epidemiology of EBV and its association with malignant disease. In: Arvin

A, Campadelli-Fiume G, Mocarski E, Moore PS, Roizman B, Whitley R, Yamanishi K, editors. Human herpesviruses:

biology, therapy, and immunoprophylaxis. Cambridge, MA: Cambridge University Press; 2007. p. 929-59.

[PubMed] [Google Scholar]

Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-108. [PubMed] [Google

Scholar]

Wahab AA, Mohammad M, Rahman MM, Said MS. Anti-cyclic citrullinated peptide antibody is a good

indicator for the diagnosis of rheumatoid arthritis. Pak J Med Sci. 2013;29(3):773-7. [PubMed] [Google Scholar]

Shidara K, Inoue E, Hoshi D, Sato E, Nakajima A, Momohara S, Taniguchi A, Yamanaka H. Anti-cyclic citrullinated peptide antibody predicts functional disability in patients with rheumatoid arthritis in a large

prospective observational cohort in Japan. Rheumatol Int. 2012;32(2):361-6. [PubMed] [Google Scholar]

Marzoq HS, Yaser SJ. Correlation between Epstein Barr virus LMP and rheumatoid arthritis patients. Biochem

Cell Arch. 2019;19(1):2023-6. [Google Scholar]

Al-Derzi AR, Alani MM, AL-Hadithi HS. Epstein-Barr virus antibodies in rheumatoid arthritis Iraqi patients. J Fac

Med Baghdad. 2013;55(4):358-61. [Google Scholar]

Masdar H. The link of Epstein Barr virus infection and rheumatoid arthritis immunopathogenesis. J Ilmu

Kedokt. 2010;4(2):79-88. [Google Scholar]