Table 3

Features of the most common virus-associated arthritides

HCV


Virus

HBV

HCV-associated arthritis

HCV-associated mixed cryoglobulinemia syndrome

HIV

Parvovirus

Alphaviruses

HTLV-I


Epidemiology

Population at risk

- IVDUs

- IVDUs

- IVDUs

- Workers at schools or day care facilities

- Travelers or inhabitants of endemic areas (Africa, South and Southeast Asia)

- Perinatal

- Persons with multiple sexual partners

- Transfusion before 1992

- Persons with multiple sexual partners

- Sexual transmission in endemic areas (Caribbean, Japan)

- Health workers

- Persons with multiple sexual partners

- Health workers

Clinical findings

Type of joint Manifestations

Polyarthritis

Polyarthritis (80%), mono-/oligo-arthritis (20%)

Polyarthralgias

Oligoarthritis

Polyarthritis

Polyarthritis

Polyarthritis

Duration of arthritis

2 to 3 weeks

Chronic

Chronic

Chronic

2 to 3 weeks

Weeks to months

Chronic

Characteristic extra-articular Manifestations

- Generalized skin rash

- Purpura

- Prodromal phase lasting 1 week with flu-like symptoms prior to arthritis

- Fever

- Vasculitis

- Fever

- Peripheral neuropathy

- Skin rash (<20% 'slapped cheeks')

- Skin rash

- Sjögren-like syndrome

- Myalgias

- Glomerulonephritis

- Myalgias

- Skin ulcers

- Headache

- Nausea

Laboratory findings

Diagnosis of associated viral infection

HBsAg (+) Anti-HBc IgM (+) ↑↑ ALT/AST

Anti-HCV (+) (EIA) and HCV RNA (+) (PCR)

Anti-HIV (+) (ELISA) and HIV RNA (+) (PCR)

IgM B19 Ab (+)

Specific IgM Abs (+) and viral RNA (+) (PCR)

Anti-HTLV-I (+) (ELISA) and Western blot or HTLV-I DNA (+) PCR (+)

RF

25% (+)

40% to

>90% (+)

Rarely (+)

Negative

Other

70% (+) Cryoglobulins: 40% (+)

Cryoglobulins: 100% (+) Low C4: 50% to 85%

X-ray findings

Erosive disease

No

No

No

Rarely

No

No

Yes

Therapy

a. Antiviral

Not needed

Peg-IFN-α + ribavirin × 6 to 12 months

HAART

Not needed

Not available

Not available

b. Treatment for the joint manifestations

- Analgesics

- Analgesics

Mild-moderate disease:

- Analgesics

- Analgesics

- Analgesics

- NSAIDs

- Low-dose prednisone

- Low-dose Prednisone

- NSAIDs

- NSAIDs

- Corticosteroids

- DMARDs (rarely)

Severe disease:

- High-dose steroids

- DMARDs (in severe cases and only if CD4 >200 mm3)

- DMARDs

- Anti-TNF (rarely)

- Cyclophosphamide

- Anti-TNF (in severe cases and only if CD4 >200 mm3)

- Rituximab ± plasmapheresis


Ab, antibody; ALT, alanine aminotransferase; anti-TNF, anti-tumor necrosis factor; AST, aspartate aminotransferase; DMARD, disease-modifying antirheumatic drug; EIA, enzyme immunoassay; ELISA, enzyme-linked immunosorbent assay; HAART, highly active antiretroviral therapy; HBV, hepatitis B virus; HCV, hepatitis C virus; HTLV-I, human T-cell lymphotropic virus type I; IFN-α, interferon-alpha; IVDU, intravenous injection drug user; NSAID, nonsteroidal anti-inflammatory drug; PCR, polymerase chain reaction; RF, rheumatoid factor.

Vassilopoulos and Calabrese Arthritis Research & Therapy 2008 10:215   doi:10.1186/ar2480