Abstract
Aim: Many studies presented some evidence that EBV might play a role in the pathogenesis of rheumatoid arthritis. Still, there are conflicting reports concerning the existence of EBV in the synovial tissue of patients suffering from rheumatoid arthritis. This systematic review assesses the causal relationship between Epstein-Barr virus (EBV) and rheumatoid arthritis (RA) for gaining a better understanding of the pathogenesis of RA. Methods: A systematic review and meta-analysis is provided aimed to answer among other questions the following question. Is there a cause effect relationship between Epstein-Barr virus and rheumatoid arthritis? The method of the conditio sine qua non relationship was used to proof the hypothesis without Epstein-Barr virus no rheumatoid arthritis. In other words, if rheumatoid arthritis is present, then Epstein-Barr virus is present too. The mathematical formula of the causal relationship k was used to proof the hypothesis, whether there is a cause effect relationship between Epstein-Barr virus and rheumatoid arthritis. Significance was indicated by a p-value of less than 0.05. Results: The studies analysed were able to provide convincing evidence that Epstein-Barr virus is a necessary condition (a conditio sine qua non) of rheumatoid arthritis. Furthermore, the studies analysed provide impressive evidence of a cause-effect relationship between Epstein-Barr virus and rheumatoid arthritis. Conclusion: EBV infection of human synovial tissues is a condition sine qua non, a condition per quam and a conditio sine qua non and conditio per quam of rheumatoid arthritis. In other words, Epstein-Barr virus is the cause of rheumatoid arthritis.
Highlights
Rheumatoid arthritis (RA), a systemic, predominantly1 CD4+ T helper type 1 (Th1)-driven disease characterized by an extensive synovial hyperplasia and infiltration by macrophages, monocytes, lymphocytes and fibroblasts
We need to take into consideration under what conditions is it appropriate to use antibodies against Epstein-Barr virus to investigate the relationship between EBV and rheumatoid arthritis? To date it is known that IgG molecules with two antigen binding sites are created and released by human plasma B cells not without any reason but i. e. to control an infection in human body
The results of the present study are consistent with the hypothesis that there is a relationship between EBV and rheumatoid arthritis (RA) and give further evidence of the linkage between EBV and RA
Summary
Rheumatoid arthritis (RA), a systemic, predominantly CD4+ T helper type 1 (Th1)-driven disease characterized by an extensive synovial hyperplasia and infiltration by macrophages, monocytes, lymphocytes and fibroblasts. At present there is no known cure for rheumatoid arthritis, an adequate use of various kinds of diseasemodifying anti-rheumatic drugs may achieve complete remission in about 30 - 50% of RA patients. In the quest to uncover the unknown etiology of rheumatoid arthritis, viruses including Epstein-Barr virus (EBV), human herpesvirus-6, human herpesvirus-8, parvovirus B19 (B19), HTLV-1, and human endogenous retroviruses-5 have all been hypothesized for many years to be involved in the pathogenesis of rheumatoid arthritis . Epstein-Barr virus (EBV) is an ancient, ubiquitous virus determined by a 184 kbp-sized, double-stranded DNA genome which has infected probably more than 90% of the world’s population. Due to conflicting reports concerning the existence of EBV in the synovial tissue of RA patients a cause or the cause of rheumatoid arthritis remains unknown
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