Viral arthritis is inflammation of the joints from a viral infection which can be acute as well as chronic. Viral arthritis is less common than bacterial arthritis.
Viruses can cause arthritis by infection or act as cofactors in the development of rheumatic diseases. The immune complexes from an antibody response can also be deposited at sites of viral infection or in the synovium.
Numerous different viruses can give rise to viral arthritis, including parvovirus B19 , hepatitis viruses hepatitis A virus, hepatitis B and C viruses, rubella virus, alphaviruses [Chikungunya virus, O’nyong-nyong virus, Ross River virus, Mayaro virus, Sindbis virus, Barmah Forest virus], retrovirus [HIV virus], Epstein Barr virus, Varicella-zoster virus, Epstein Barr virus, Mumps virus, Adenovirus or coxsackieviruses A9, B2, B3, B4, and B, Echovirus, Herpes simplex virus or cytomegalovirus.
Viral arthritis occur all over the world. Its incidence and prevalence are not known and vary with types of viruses and their geographical distribution.
Presentation of Viral Arthritis
Viral arthritis involves joints symmetrically. Usually the peripheral joint like hands, wrists, elbows, knees and knees may be affected. Affected joints swell and become stiff especially in the morning. Joint and soft-tissue involvement occur with different viral infections.
Viral arthritis is not destructive in nature. Physical findings in patients with viral arthritis vary with the type of virus causing the arthritis.
Other features particular to viral illness may be present.
Complete blood count, markers of inflammation like ESR, CRP, liver function tests are done to know patient’s general condition. Viral specific serology helps to identify and confirm viruses.
Imaging of Viral Arthritis
Most of the virus-associated arthropathies are nonerosive and show only soft-tissue swelling. However, with HIV-related seronegative or psoriatic-type arthropathy, erosions, ankylosis, narrowing of joint spaces, whittling, osteolytic lesions, periostitis, sacroiliac joint-space widening, and syndesmophyte formation can be seen.
Aspiration of the joint is useful to help rule out other conditions, such as crystal arthropathy or bacterial infection.
Treatment of Viral Arthritis
Viral arthritis is mild and requires only symptomatic treatment. NSAIDs, low dose prednisone is used and virus specific drugs when needed are used.
Surgical drainage is not indicated unless septic arthritis is considered likely. Gentle mobilization may be initiated after a few days of rest.
In hepatitis C virus infection, interferon alfa-2b is given in a dosage of 3-5 million U 2-3 times a week for 6 months. Combination therapy that adds ribavirin 1000-1200 mg/day is recommended and has been shown to yield better response rates.
For cases involving HIV infection, use a combination of newer antiretroviral agents, sulfasalazine and methotrexate can be added.
Intravenous immune globulin, interleukins and interferon gamma may be effective in some HIV-patients with arthritis.
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