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For further information, see CMDT Part 20-38: Viral Arthritis

Key Features

  • Arthralgias occur frequently in the course of acute infections with many viruses, but frank arthritis is uncommon

Clinical Findings

  • Acute parvovirus (erythrovirus) B19 infection

    • Leads to acute polyarthritis in 50–60% of adult cases (infected children develop the febrile exanthem known as "slapped cheek fever")

    • The arthritis can mimic rheumatoid arthritis but is almost always self-limited and resolves within several weeks

  • Acute hepatitis B infection

    • Self-limited polyarthritis typically occurs before the onset of jaundice

    • Urticaria or other types of skin rash may be present

    • The clinical picture resembles that of serum sickness

    • Serum transaminase levels are elevated, and tests for hepatitis B surface antigen are positive

    • Serum complement levels are often low during active arthritis and become normal after remission of arthritis

  • Chronic infection with hepatitis C

    • Associated with chronic polyarthralgia in up to 20% of cases and with chronic polyarthritis in 3–5%

    • Both can mimic rheumatoid arthritis, and the presence of rheumatoid factor in most hepatitis C–infected individuals leads to further diagnostic confusion

    • Hepatitis C–associated arthritis is frequently misdiagnosed as rheumatoid arthritis

      • Hepatitis C–associated arthritis is nonerosive

      • Rheumatoid arthritis always causes objective arthritis (not just arthralgias) and can be erosive

      • The presence of anti-CCP antibodies points to the diagnosis of rheumatoid arthritis

  • Chikungunya virus

    • Distinguishing it from dengue fever can be challenging since both can cause high fever, rash and incapacitating bone pain

    • However, polyarthralgia and polyarthritis develop much more commonly with chikungunya infection and can persist for months or years


  • Viral serologies


  • NSAIDs are the mainstay of treatment for most forms of viral arthritis

  • Symptoms secondary to hepatitis C virus may respond to peginterferon-alpha-2b or peginterferon-alpha-2a plus ribavirin if the virologic response is good

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