Viral Causes of Arthritis

1. Rubella virus
   1. Metacarpal and proximal interphalangeal joints
   2. Accompanied by rash
   3. Duration: days to weeks
2. 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
3. Mumps Virus
   1. Large joints involved 1-2 weeks after parotid swells
   2. Duration: 2 weeks
   3. Rarely occurs in children
4. Varicella Zoster Virus (Chicken Pox)
   1. Similar arthritis as seen with MumpsVirus
   2. Bacterial Superinfection may result in Septic Arthritis
5. 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
6. Hepatitis Viruses
   1. Hepatitis AVirus (occurs in 10-14% of cases)
      1. Arthralgia and rash occur during acute phase
   2. Hepatitis BVirus (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 CVirus
      1. Rapidly progressive acute arthralgias and myalgias
      2. Joint pain out of proportion to clinical signs
      3. Associated with development of Rheumatoid Arthritis
7. 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
8. Alphaviruses (Mosquito borne)
   1. Sindbis Virus (Africa and Australia)
   2. ChikungunyaFever (Africa and Asia)
   3. O'nyong-nyong Virus (Africa)
   4. Ross River Virus (South Pacific, Australia)
   5. Mayaro Virus (South America)
9. References
   1. Klippel (1997) Primer Rheumatic Diseases, p. 201-4
   2. Siegel (1996) Am Fam Physician 54(6):2009-15
   3. Ytterberg (1999) Curr Opin Rheumatol 11:275-80