Table 3 Features of the most common virus-associated arthritides
From: Virally associated arthritis 2008: clinical, epidemiologic, and pathophysiologic considerations
| Â | Â | HCV | Â | Â | Â | Â | |
|---|---|---|---|---|---|---|---|
Virus | HBV | HCV-associated arthritis | HCV-associated mixed cryoglobulinemia syndrome | HIV | Parvovirus | Alphaviruses | HTLV-I |
Epidemiology | Â | Â | Â | Â | Â | Â | Â |
Population at risk | Â | Â | Â | Â | Â | Â | Â |
| Â | - IVDUs | - IVDUs | Â | - IVDUs | - Workers at schools or day care facilities | - Travelers or inhabitants of endemic areas (Africa, South and Southeast Asia) | - Perinatal |
| Â | - Persons with multiple sexual partners | - Transfusion before 1992 | Â | - Persons with multiple sexual partners | Â | Â | - Sexual transmission in endemic areas (Caribbean, Japan) |
| Â | - Health workers | - Persons with multiple sexual partners | Â | Â | Â | Â | Â |
| Â | Â | - Health workers | Â | Â | Â | Â | Â |
Clinical findings | Â | Â | Â | Â | Â | Â | Â |
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 | Â | - Purpura | Â | - 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 |
| Â | - Myalgias | Â | - Glomerulonephritis | Â | Â | - Myalgias | Â |
| Â | Â | Â | - Skin ulcers | Â | Â | - Headache | Â |
| Â | Â | Â | Â | Â | Â | - Nausea | Â |
Laboratory findings | Â | Â | Â | Â | Â | Â | Â |
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% (+) | Â | Rarely (+) | Negative | Â |
Other | Â | 70% (+) Cryoglobulins: 40% (+) | Cryoglobulins: 100% (+) Low C4: 50% to 85% | Â | Â | Â | Â |
X-ray findings | Â | Â | Â | Â | Â | Â | Â |
Erosive disease | No | No | No | Rarely | No | No | Yes |
Therapy | Â | Â | Â | Â | Â | Â | Â |
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 |
| Â | Â | - Low-dose prednisone | - Low-dose Prednisone | - NSAIDs | Â | - NSAIDs | - Corticosteroids |
| Â | Â | - DMARDs (rarely) | Severe disease: - High-dose steroids | - DMARDs (in severe cases and only if CD4 >200 mm3) | Â | Â | - DMARDs |
| Â | Â | - Anti-TNF (rarely) | - Cyclophosphamide | - Anti-TNF (in severe cases and only if CD4 >200 mm3) | Â | Â | Â |
|  |  |  | - Rituximab ± plasmapheresis |  |  |  |  |