Viral Arthritis Treatment & Management

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

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]

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Surgical Care

Surgical drainage is not indicated unless septic arthritis is considered likely.

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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
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Diet

No restrictions are necessary.

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Activity

Recommend gentle mobilization after a few days of rest.

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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

References

  1. Albert LJ, Inman RD. Molecular mimicry and autoimmunity. N Engl J Med. Dec 30 1999;341(27):2068-74. [Medline].

  2. Heegaard ED, Taaning EB. Parvovirus B19 and parvovirus V9 are not associated with Henoch-Schönlein purpura in children. Pediatr Infect Dis J. Jan 2002;21(1):31-4. [Medline].

  3. Ali Ou Alla S, Combe B. Arthritis after infection with Chikungunya virus. Best Pract Res Clin Rheumatol. Jun 2011;25(3):337-46. [Medline].

  4. Pattamapaspong N, Louthrenoo W. Musculoskeletal infection in acquired immunodeficiency syndrome. Semin Musculoskelet Radiol. Nov 2011;15(5):541-53. [Medline].

  5. Koturoglu G, Kurugol Z, Cetin N, et al. Complications of varicella in healthy children in Izmir, Turkey. Pediatr Int. Jun 2005;47(3):296-9. [Medline].

  6. Keyser FD. Choice of Biologic Therapy for Patients with Rheumatoid Arthritis: The Infection Perspective. Curr Rheumatol Rev. Feb 2011;7(1):77-87. [Medline]. [Full Text].

  7. Molnar-Kimber KL, Kimber CT. Each type of cause that initiates rheumatoid arthritis or RA flares differentially affects the response to therapy. Med Hypotheses. Nov 1 2011;[Medline].

  8. Gutierrez K. Bone and joint infections in children. Pediatr Clin North Am. Jun 2005;52(3):779-94, vi. [Medline].

  9. McCarthy JJ, Dormans JP, Kozin SH, et al. Musculoskeletal infections in children: basic treatment principles and recent advancements. Instr Course Lect. 2005;54:515-28. [Medline].

  10. Medina Rodríguez F. Rheumatic manifestations of human immunodeficiency virus infection. Rheum Dis Clin North Am. Feb 2003;29(1):145-61, viii. [Medline].

  11. Moylett EH, Shearer WT. HIV: clinical manifestations. J Allergy Clin Immunol. Jul 2002;110(1):3-16. [Medline].

  12. Murphy FA, Fauquet CM, Bishop DHL, et al. Virus Taxonomy. The Sixth Report of the International Committee on Taxonomy of Viruses. New York, NY: Springer-Verlag; 1995..

  13. Naides SJ. Viral Arthritis. In: Koopman WJ, ed. Arthritis and Allied Conditions: A Textbook of Rheumatology. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:2649-68.

  14. Naides SJ. parvoviruses. In: Specter S, Hodinka R L, Young SA. Clinical virology manual. 1. 3rd ed. New York: Elsevier science; 2000:487-500.

  15. Naides SJ. Viral Arthritis. In: Ruddy S, Sledge CB, Harris ED, eds. Kelley's Textbook of Rheumatology. Vol 2. New York, NY: Elsevier Science; 2000:1519-27.

  16. Naides SJ. Viral Arthritis. In: Klippel JH, Crofford L, eds. Primer on the Rheumatic Diseases. 12th ed. Atlanta, Ga: Arthritis Foundation; 2001:265-8.

  17. Pinals RS. Polyarthritis and fever. N Engl J Med. Mar 17 1994;330(11):769-74. [Medline].

  18. Scott M. Viral causes of arthritis. Family Practice Notebook.com [online]. Available at: http://www.fpnotebook.com/ID192.htm. 2002. [Full Text].

  19. Siegel LB, Gall EP. Viral infection as a cause of arthritis. Am Fam Physician. Nov 1 1996;54(6):2009-15. [Medline].

  20. Stanley J Naides. Viral Arthritis. In: M C Hochberg,A Silman,J Smolen,M Weinblatt, M Weisman. RHEUMATOLOGY. Two. 3rd. Toronto: MOSBY , Elsevier Limited; 2003:1105-1113. [Full Text].

  21. Tan LC, Mowat AG, Fazou C, Rostron T, Roskell H, Dunbar PR, et al. Specificity of T cells in synovial fluid: high frequencies of CD8(+) T cells that are specific for certain viral epitopes. Arthritis Res. 2000;2(2):154-64. [Medline]. [Full Text].

  22. Ytterberg SR. Viral arthritis. Curr Opin Rheumatol. Jul 1999;11(4):275-80. [Medline].

 
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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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