Arthritis caused by virus

Kelley and Firestein's Textbook of Rheumatology. Philadelphia, PA: Elsevier; chap Ohl CA. Infectious arthritis of native joints. Updated by: Jatin M. Editorial team. Exams and Tests. Outlook Prognosis. When to Contact a Medical Professional. Call for an appointment with your provider if arthritis symptoms last longer than a few weeks. The resolution of the underlying infection will usually resolve the arthritis symptoms.

Symptoms of viral arthritis tend to develop suddenly, be of short duration, and not recur. Many cases of viral arthritis resolve within six weeks. The joint symptoms often are preceded by or coincide with the signs and symptoms of a viral infection such as fever, muscle ache, and fatigue.

In some cases, there may be a rash similar to that seen in rheumatic diseases. Viral arthritis also tends to manifest with polyarthritis arthritis in more than five joints.

People with pre-existing osteoarthritis or rheumatoid arthritis may experience a worsening of joint symptoms due to the rapid onset of viral inflammation. Viral arthritis does generally not cause joint destruction, although some viral causes like the chikungunya virus may cause joint pain for months and even years after the infection has cleared.

Viruses can sometimes invade a joint during an infection. When this occurs in the synovium or surrounding tissues, the viral particles are recognized as antigens substances that trigger an immune response by the immune system. In such an event, the immune system will not only attacks the viruses freely circulating in the bloodstream but also deposits substances called immune complexes into the joint space. Immune complexes help defensive antibodies bind to antigens but also trigger acute inflammation, causing joint pain and swelling.

Viral arthritis is the result. The viruses most commonly linked to viral arthritis include:. Other viruses less commonly associated with viral arthritis include the hepatitis E virus HEV , human T-lymphotropic virus type-1 HTLV-1 , enteroviruses , and the dengue virus. Due to the widespread vaccination of mumps and other viral diseases, viral arthritis is less common in the United States than it once was. Diagnosis of viral arthritis can be tricky because there is no single presentation of the disease that is considered "typical.

Moreover, different viruses affect different organs and can manifest with a wide variety of symptoms. Viral arthritis caused by HBV, for example, can manifest with jaundice yellowing of the eyes and skin , while viral arthritis caused by the rubella virus may present with a widespread rash.

Viral arthritis should be suspected if multiple joints on both sides of the body are affected, and the joint symptoms are accompanied by or preceded by symptoms of systemic infection. Viral arthritis is diagnosed with blood tests that confirm the underlying infection. These may include:. Depending on the suspected cause, these and other tests may be performed.

Immunoglobulin tests are especially useful in directing the appropriate treatment based on whether the infection is acute as indicated by an elevated IgM or persistent as indicated by a stable elevation of IgG. Additional blood tests may also be ordered to rule out other possible causes for the joint symptoms.

The treatment of viral arthritis focuses on symptom relief and the restoration of joint function. In some cases, treatments will be started presumptively since they are commonly used to treat many inflammatory joint conditions.

Other prescription treatments may be delayed until more definitive results are obtained. Treatment options for viral arthritis may include:. Corticosteroids are generally avoided since they can mask or worsen the underlying viral disease. The pattern of arthritis is symmetrical, migratory and additive, involving the small joints of the hands, wrists and knees.

Similar to infection with parvovirus B19, arthralgias are more common that a true arthritis. Tenosynovitis may also be present. In the majority of cases, joint symptoms resolve within several weeks. Risk Factors: Rubella has been eliminated from the United States through introduction of the rubella vaccine in Prior to widespread vaccination, outbreaks of rubella would occur periodically during winter and spring months, with highest incidence seen in school-age children.

Globally, rubella infection still occurs in countries that have not implemented vaccination programs. Diagnosis: Diagnosis is made though detection of IgM-specific antibodies using an enzyme immunoassay. Clinical: HCV infects nearly million people worldwide and in the majority of cases is not clinically diagnosed. Risk factors: Intravenous drug use, high risk sexual activity, transfusion of blood products before Diagnosis: In the United States, screening tests are recommended for all individuals born between and irrespective of signs or symptoms.

Anti-CCP antibodies are not detected in the vast majority of patients. Treatment: In general the initial approach to a patient with active HCV infection and presumed musculoskeletal symptoms arthralgia, arthritis, tenosynovitis etc.

For patients unable to receive or failing such therapy the use of anti-rheumatic drugs of the lowest toxicity is preferred. Clinical: HBV is a global pathogen estimated to infect million individuals.

It is considered a de-accelerating pathogen due to the success of global immunization. HBV has been associated with several rheumatic syndromes including acute polyarthritis which can resemble both acute rheumatoid and the classic syndrome of polyarteritis nodosa. In recent years these are considered extremely rare. Of greater concern in the modern era is the syndrome of HBV reactivation in patients undergoing immunosuppressive therapy.

Risk Factors: Intravenous drug use, high risk sexual activity, transfusion of blood products before or immigration from a geographic area of high endemic infection rates i. Diagnosis: In a patient with risk factors for HBV and acute polyarthritis often accompanied by a small vessel vasculitis i. Unexplained elevations of liver enzymes may be an initial clue; jaundice and liver failure are often absent. Management: Patients with acute HBV arthritis or polyarteritis need to be immediately referred to hepatology for prompt administration of antiviral therapy.

In most cases, adjunctive immunosuppression may be unnecessary or short-term. Clinical: HIV is worldwide pandemic that still infects 37 million people. Over the course of the past nearly four decades and in particular since the introduction of combination antiretroviral therapy, HIV infection has transformed into a chronic, complex, but manageable disease.

Rheumatic syndromes, which included reactive arthritis-like illness, psoriatic arthritis and idiopathic inflammatory arthritis of undetermined etiology have become exceeding rare but still persist. Any rheumatic symptom or sign that is medically unexplained in an HIV infected patient should be considered potentially HIV-related.

Risk Factors: Intravenous drug use, high risk sexual activity, transfusion of blood products before Diagnosis: HIV testing is constantly evolving and current tests 4 th generation utilize a screening strategy that automatically employs ELISA screening and confirmatory follow up testing obviating the need to confirm with Western Blot testing as in the past. Management: Any patient with documented HIV infection must be referred to a clinician with explicit expertise in the management of the disease.

In general, many rheumatic manifestations that cannot be explained independently must be considered potentially HIV-related. Furthermore many HIV infected patients, many of whom are aging, may present with nosologically defined rheumatic diseases i.