How does Epstein-Barr virus raise the risk of autoimmune disease?
Epstein-Barr virus (EBV) raises the risk of autoimmune disorders, in which the immune system attacks the body’s own parts. In people with chronic autoimmune disease the virus wakes back up. Researchers now tie that EBV autoimmunity to adhesive arachnoiditis. That condition causes chronic, intractable spinal pain.
Autoimmune disorders are hard to manage. The immune system should guard the organs, but it turns on them instead. That makes these disorders hard to treat, since holding down immunity is the only way to manage them. And doctors still cannot fully control immune responses. That makes it hard to deliver migraine headache relief as well as chronic pain treatment.
Researchers also want to know what causes autoimmune disorders. Why does immunity act this way in some people? Genes cannot fully explain the risk of chronic autoimmune diseases. Researchers have long suspected that certain viruses raise the risk of autoimmune disorders and even some cancers.
New studies point to Epstein-Barr virus (EBV). It is a herpes-family virus that lives in the body of most people. In some people it suddenly turns active, for reasons no one fully knows. This sudden EBV activation seems to set off an immune response. That response raises the risk of autoimmune disorders.
Researchers now call this “EBV autoimmunity.” Some experts say it is the biggest cause of multiple sclerosis, lupus, and rheumatoid arthritis. They also say it causes about 2% of all cancers.
How is Epstein-Barr virus linked to arachnoiditis?
Adhesive arachnoiditis (AA) has long been known as a severe inflammatory condition. It often causes chronic and even intractable pain. In AA, inflammation glues the cauda equina nerve roots in the spine to the arachnoid lining of the spinal canal. The result is chronic pain and disability. Researchers have long thought this inflammation is tied to autoimmunity. Now the evidence for that idea keeps growing.
In a recent study, researchers reviewed the MRI data of 800 patients living with AA. Their past health records showed a clear pattern. All of them had major spinal disc problems before they developed AA.
Even more striking, most of these people had some kind of autoimmune disorder. The list included fibromyalgia, Hashimoto’s thyroiditis, migraine, burning mouth or feet, chronic fatigue, arthritis, and so on. So researchers concluded that AA in these people was a late complication of autoimmune disease.
Studies already link EBV to autoimmunity. So the team tested the AA patients for EBV. Most of the people with this chronic, painful condition were positive for EBV. They also showed signs that the virus had woken back up. AA patients also had high antibody levels against other germs often tied to autoimmunity. These included cytomegalovirus, other herpes strains, and Lyme disease.
The team says there is no doubt that EBV plays a key role in autoimmune disorders. Their study now shows that AA is a late-stage complication of autoimmune diseases driven by EBV reactivation (the virus waking back up). So EBV reactivation also plays a key role in AA. That means EBV antibodies must be tested in people living with AA. They should also be tested in other conditions marked by chronic or intractable pain. This will help most in chronic pain treatment and migraine headache relief.
Frequently asked questions
What autoimmune diseases can EBV trigger?
Some experts call EBV autoimmunity the biggest cause of multiple sclerosis, lupus and rheumatoid arthritis. They also tie it to about 2% of all cancers. People with adhesive arachnoiditis often had other conditions, too. These included fibromyalgia, Hashimoto’s thyroiditis, migraine, burning mouth or feet, chronic fatigue and arthritis. Most of them tested positive for reactivated EBV.
What triggers the Epstein-Barr virus?
No one knows exactly. EBV is a herpes-family virus that lives in the body of most people. In some, it suddenly turns active again, for reasons that are still poorly understood. That reactivation sets off an immune response that raises the risk of autoimmune disease. Genes alone do not explain who gets autoimmune disease. That is why researchers look hard at viruses like EBV.
Is arachnoiditis an autoimmune disease?
The evidence keeps pointing that way. Adhesive arachnoiditis is inflammation that glues the cauda equina nerve roots to the lining of the spinal canal. One team reviewed 800 patients with it. All had major disc problems first, and most had an autoimmune disorder. They concluded that arachnoiditis in these patients is a late complication of autoimmune disease driven by EBV reactivation.
Is Epstein-Barr a chronic illness?
EBV is a herpes-family virus that lives in the body of most people. In most it stays quiet. In some, it suddenly turns active again. That reactivation sets off an immune response tied to chronic autoimmune disease. Most of the patients with adhesive arachnoiditis who were tested had reactivated EBV. Researchers also found high antibody levels against cytomegalovirus, other herpes strains and Lyme disease.
Should people with chronic pain be tested for Epstein-Barr virus?
The researchers behind the arachnoiditis study say yes. Arachnoiditis appears to be a late complication of autoimmune disease driven by EBV reactivation. So they call for testing EBV antibodies in people living with arachnoiditis. They also call for it in other conditions marked by chronic or intractable pain. Knowing the virus is active helps guide chronic pain treatment and migraine headache relief.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
