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Table 3 Features of the most common virus-associated arthritides

From: Virally associated arthritis 2008: clinical, epidemiologic, and pathophysiologic considerations

   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     
  1. 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.