Viral Arthritis 

  • Author: Rabea Ahmed Khouqeer, MD, FRCP(C); Chief Editor: Herbert S Diamond, MD   more...
 
Updated: Nov 29, 2011
 

Background

Viral arthritis is characterized by inflammation of the joints caused by a viral infection. Identifying and understanding the pathophysiologic mechanisms by which viral arthritis causes acute and chronic arthropathies is crucial to understanding its immunopathogenesis. Alterations of the immune system can lead to acute forms of arthritis, which can be followed by chronic arthralgia or arthritis (ie, overrepresentation of CD8+ T lymphocytes in the synovial fluid of individuals with rheumatoid arthritis or Epstein-Barr virus infection).

The number of patients diagnosed with acute viral arthritis is relatively low because of its late presentation. New technologies now provide simpler, faster, more reliable, and more sensitive tests for viral diagnosis; additionally, antiviral treatment is now available.

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Pathophysiology

Viruses are agents that cause infection or cofactors in the development of rheumatic diseases. Viral infection depends on host and viral factors. Host factors are very important and include age, sex, genetic background, infection history, and immune response. Viral factors include the mode of host entry, tissue tropism, replication, the effects of cytokines, the ability to establish persistent or latent viral infections, and alterations of host antigens. Infected cells can undergo apoptosis (programmed cell death).

The immune complexes from an antibody response can be deposited at sites of viral infection or in the synovium. Virus-induced autoimmunity, polyclonal B-cell activation, and immunodeficiency may result in opportunistic infection, largely because of an inability of the immune system to eliminate the virus (eg, HIV, human T-lymphotropic virus 1 [HTLV-I], hepatitis C virus [HCV]). Molecular mimicry may cause abnormal self-reactivity by altering immune tolerance.[1]

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Epidemiology

Frequency

United States

Although not uncommon, the exact incidence and prevalence rates of viral arthritis are unknown and vary with the type of virus and the age range of specific population groups. However, approximately 2.7 million people are infected with HCV in the United States, and perhaps 0.01% of the population is infected with hepatitis B virus (HBV).

International

Although precise international incidence and prevalence rates are unknown, viral arthritis occurs worldwide. The rate of HBV infection is higher in Asia (China, 10% of the population), the Mideast, and sub-Saharan Africa. HCV infection rates are higher in Africa and Asia.

Mortality/Morbidity

The major morbidity of viral arthritis is dysfunctional joints. The mortality rate depends on the type of virus and duration of infection.

Race

Viral arthritis has no recognized racial or ethnic predilection.

Sex

Parvovirus B19 infection is more common in women than in men. Whether hepatitis A virus or HCV has a predilection for either sex is unknown.

Age

Adulthood viral infection rates may be higher than in childhood or vice versa, depending on the virus. HBV infection rates in childhood may be as high as 5% annually. In adulthood, HBV is transmitted through sexual activity or needle exposures. Children are more susceptible to infection with parvovirus B19 than adults, although arthritis rarely occurs in children. Up to 60% of adults have serologic evidence of past parvovirus B19 infection.

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Contributor Information and Disclosures
Author

Rabea Ahmed Khouqeer, MD, FRCP(C)  Consultant, Department of Medicine, Division of Allergy and Clinical Immunology/Rheumatology, Saad Specialist Hospital, Saudi Arabia

Rabea Ahmed Khouqeer, MD, FRCP(C) is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American College of Rheumatology

Disclosure: allergy, Asthma & Immunology None None

Coauthor(s)

Martin Cohen, MD  Adjunct Professor, Department of Medicine, McGill University Health Center

Martin Cohen, MD is a member of the following medical societies: American College of Rheumatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Kristine M Lohr, MD, MS  Professor, Department of Internal Medicine, Center for the Advancement of Women's Health and Division of Rheumatology, Director, Rheumatology Training Program, University of Kentucky College of Medicine

Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Elliot Goldberg, MD  Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Adjunct Professor of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

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Viral arthritis. Typical "slapped cheek" appearance. Courtesy of Brenda Moroz, MD, Montreal Children's Hospital.
Viral arthritis. "Slapped cheeks" with typical reticulated erythema of arms. Courtesy of Brenda Moroz, MD, Montreal Children's Hospital.
 
 
 
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