20-37: Rheumatic Manifestations of HIV Infection

Infection with HIV has been associated with various rheumatic disorders, most commonly arthralgias and arthritis. HIV painful articular syndrome causes severe arthralgias in an oligoarticular, asymmetric pattern that resolve within 24 hours; the joint examination is normal. HIV-associated arthritis is an asymmetric oligoarticular process with objective findings of arthritis and a self-limited course that ranges from weeks to months. Psoriatic arthritis and reactive arthritis occur in HIV-infected individuals and can be severe. Along with antiretroviral therapies, immunosuppressive medications can be used if necessary in HIV-infected patients, though with caution. Muscle weakness associated with an elevated creatine kinase can be due to nucleoside reverse transcriptase inhibitor-associated myopathy or HIV-associated myopathy; the clinical presentations of each resemble idiopathic polymyositis but the muscle biopsies show minimal inflammation. Less commonly, an inflammatory myositis indistinguishable from idiopathic polymyositis occurs. Other rheumatic manifestations of HIV include diffuse infiltrative lymphocytosis syndrome (with parotid gland enlargement) and various forms of vasculitis. The use of antiretroviral therapy has been associated with a marked decreased frequency of painful articular syndromes, psoriatic arthritis, spondyloarthropathy, diffuse infiltrative lymphocytosis syndrome, and an increased frequency of the immune reconstitution inflammatory syndrome (IRIS) and osteoporosis.