Arthritis, Viral

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

Diagnosis

• Viral serologies

Treatment

• 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