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