Viral Causes of Arthritis

Aka: Viral Causes of Arthritis, Viral Arthritis

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II. Causes: Rubella virus

  1. Metacarpal and proximal interphalangeal joints
  2. Accompanied by rash
  3. Duration: days to weeks

III. Causes: Parvovirus B19 (Erythema Infectiosum)

  1. Severe sudden onset Polyarticular Arthritis
  2. Occurs in 60% of infected adults (rare in children)
  3. Duration: temporary, but may last years

IV. Causes: Mumps Virus

  1. Large joints involved 1-2 weeks after parotid swells
  2. Duration: 2 weeks
  3. Rarely occurs in children

V. Causes: Varicella Zoster Virus (Chicken Pox)

  1. Similar Arthritis as seen with Mumps Virus
  2. Bacterial Superinfection may result in Septic Arthritis

VI. Causes: Human Immunodeficiency Virus (HIV Infection)

  1. Acute Retroviral Syndrome (HIV Presentation)
    1. Associated with Arthralgias and Myalgias in 50-70%
  2. Subacute Oligoarticular Arthritis of knees and ankles
    1. Transient over weeks to 2 months
    2. Responds to NSAIDs
  3. Painful articular syndrome (10% of cases)
    1. Intermittent severe Joint Pain lasts less than 1 day
    2. Involves Shoulders, knees and elbows
    3. Pain may be incapacitating and require Narcotics
  4. HIV Associated rheumatic conditions
    1. Reactive Arthritis (Reiter's Syndrome)
    2. Psoriatic Arthritis
    3. Fibromyalgia

VII. Causes: Hepatitis Viruses

  1. Hepatitis A Virus (occurs in 10-14% of cases)
    1. Arthralgia and rash occur during acute phase
  2. Hepatitis B Virus (occurs in 20-25% of cases)
    1. Sudden, Severe, symmetric, Polyarticular Arthritis
    2. Resolves before Jaundice onset
    3. Chronic Arthritis may occur in Chronic Hepatitis B
    4. Significant morning stiffness
    5. Hand and Knee Joints most commonly affected
  3. Hepatitis C Virus
    1. Rapidly progressive acute Arthralgias and myalgias
    2. Joint Pain out of proportion to clinical signs
    3. Associated with development of Rheumatoid Arthritis

VIII. Causes: Assorted viruses

  1. Causes
    1. Enteroviruses
    2. Adenoviruses
    3. Arboviruses
    4. Epstein-Barr Virus
  2. Joint involvement follows acute viral syndrome
    1. Upper Respiratory Infection
    2. Gastroenteritis (Coxsackievirus or Adenovirus)
  3. Severe chronic Arthritis may develop

IX. Causes: Alphaviruses (Mosquito borne)

  1. Sindbis Virus (Africa and Australia)
  2. Chikungunya Fever (Africa and Asia)
  3. O'nyong-nyong Virus (Africa)
  4. Ross River Virus (South Pacific, Australia)
  5. Mayaro Virus (South America)

X. References

  1. Klippel (1997) Primer Rheumatic Diseases, p. 201-4
  2. Siegel (1996) Am Fam Physician 54(6):2009-15 [PubMed]
  3. Ytterberg (1999) Curr Opin Rheumatol 11:275-80 [PubMed]

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