S. Guta, O. Abrahamovych, U. Abrahamovych, L. Tsyhanyk, V. Chemes

Danylo Halytsky Lviv National Medical University

Introduction. Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology, in the origin and pathogenesis of which cytomegalovirus (CMV) and M. A. Epstein – Y. Barr virus (EBV) play an important role. There is a need to find in patients with SLE such clinical and laboratory markers identified from the obligatory diagnostic criteria of the disease, which would allow in such conditions to inform about the presence of this active viral infection.

The aim of the study. To determine the frequency of necessary clinical and laboratory diagnostic criteria for systemic lupus erythematosus in the presence of active cytomegalovirus and M. A. Epstein – Y. Barr virus, their diagnostic value.

Materials and methods. 120 patients with SLE were included in the study. To diagnose CMV and EBV infection, antibodies to viruses and their deoxyribonucleic acid (DNA) were detected. All patients were divided into four groups, namely: with active CMV infection, active EBV, active CMV and EBV and without active CMV and EBV.

Results. We found that patients with SLE and active CMV infection are significantly more likely than patients with SLE without active infections to have arthritis, psychosis, leukopenia, increased antibody titers to double-stranded DNA (anti-DNA) and antiphospholipid antibodies; and arthritis, psychosis, leukopenia and increased titer of antiphospholipid antibodies have the highest diagnostic value for the diagnosis of active CMV infection. The patients with SLE and active EBV infection significantly more often than in patients without active infections to have photosensitization, ulcers of mucous membranes, thrombocytopenia and increased titer of anti-DNA, and photosensitization, mucosal ulcers and thrombocytopenia have the highest diagnostic value for the diagnosis of active EBV infection. The patients with SLE and a combination of active CMV and EBV are significantly more likely than patients with SLE and without active infections to have “butterfly” erythema, lymphopenia, detection of lupus anticoagulant and increased titer of antinuclear antibodies, and “butterfly” erythema, lymphopenia and the appearance of lupus anticoagulant have  the highest diagnostic value of active CMV and EBV.

Conclusions. In patients with systemic lupus erythematosus and active cytomegalovirus infection, among the necessarily diagnostic criteria for systemic lupus erythematosus clinical and laboratory markers are significantly more often arthritis, psychosis, leukopenia, increased antibody titer to double-stranded deoxyribonucleic acid and antiphospholipid antibodies than in patients with systemic lupus erythematosus without these active infections. In patients with active M. A. Epstein – Y. Barr virus there are significantly more often photosensitization, ulcers of mucous membranes, thrombocytopenia and increased titer of antibodies to double-stranded deoxyribonucleic acid than in patients with systemic lupus erythematosus without these active infections.. In patients with a combination of active cytomegalovirus and M. A. Epstein – Y. Barr virus are significantly more often “butterfly” erythema, lymphopenia, the appearance of lupus anticoagulant and increased titer of antinuclear antibodies than in patients with systemic lupus erythematosus without these active infections.

Such clinical and laboratory markers as arthritis, or psychosis, or leukopenia or increase in the titer of antiphospholipid antibodies allow to suspect patients with the presence of active cytomegalovirus; photosensitization, or ulcers of mucous membranes, or thrombocytopenia – active M. A. Epstein – Y. Barr virus; “butterfly” erythema, or lymphopenia, or the appearance of lupus anticoagulant – a combination of active cytomegalovirus and M. A. Epstein – Y. Barr virus, the final verification of which requires the use of direct serological tests.

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