Viral Arthritis Treatment & Management
- Author: Rabea Ahmed Khouqeer, MD, FRCP(C); Chief Editor: Herbert S Diamond, MD more...
Medical Care
In general, viral arthritis is mild and requires only symptomatic treatment with analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs). Occasionally, a brief course of low-dose prednisone is used.
- Parvovirus B19: Treatment is symptomatic with analgesics and NSAIDs. In severe cases, aspiration of fluid from the affected joint may relieve pain.
- Hepatitis A virus: Treatment is symptomatic with analgesics and NSAIDs. Prophylaxis for contacts is an important element of management.
- Hepatitis B virus: No evidence indicates that early therapy for acute HBV infection with interferon alfa or antiviral agents decreases the rate of chronicity or speeds recovery. Most patients with acute icteric HBV infection recover without residual injury or chronic hepatitis. Focus management of acute HBV infection on avoidance of further hepatic injury and prophylaxis of contacts.
- Hepatitis C virus: Administer interferon alfa-2b (3-5 million U 2-3 times/wk for 6 mo). Combination therapy with ribavirin (1000-1200 mg/d) is recommended and has been shown to yield better response rates. Patients with complications of cryoglobulinemia are best treated with antiviral therapy. However, corticosteroids and cyclophosphamide may be initially required in patients with more active, severe vasculitic complications.
- Rubella virus: Treatment is symptomatic with analgesics and NSAIDs. Some investigators have recommended steroids at low-to-moderate doses to control symptoms and viremia.
- Alphaviruses: Treatment is symptomatic with analgesics and NSAIDs, but avoid aspirin in order to prevent a hemorrhagic component with alphavirus rashes. Chloroquine phosphate (250 mg/d) has been used when NSAIDs are not effective.
- Human immunodeficiency virus
- Use a combination of newer antiretroviral therapy.
- Treatment is symptomatic with analgesics and NSAIDs.
- Administer sulfasalazine and methotrexate in patients with conditions refractory to NSAID therapy.
- Prednisone, antimalarials, and other agents have been used successfully in patients with polymyositis, reactive arthritis, Sjögrenlike syndrome, psoriatic arthritis, and vasculitis.
- Antiretroviral and prophylactic therapy, sulfamethoxazole-trimethoprim, and pentamidine help improve associated rheumatic symptoms.
- Intravenous immune globulin, interleukin-12, interleukin-2, interferon-gamma, and/or sargramostim may be effective in some patients infected with HIV who have arthritis.
- Human T-lymphotropic virus 1: Treatment options are poor.
In patients with rheumatoid arthritis, the elevated risk of infection due to relative suppressed immunosuppression must be carefully assessed.[6] A better understanding of the cause of flare-ups would help predict patient responses to various therapies.[7]
Surgical Care
Surgical drainage is not indicated unless septic arthritis is considered likely.
Consultations
In general, patients can initially be seen by their family doctors. In patients who do not improve or in whom the treatment response is poor, the following practitioners may be consulted:
- Rheumatologists
- Hepatologists (if HBV or HCV infection is considered)
- Infectious disease specialists
- Immunologists
Diet
No restrictions are necessary.
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