Viral Arthritis Workup

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

Laboratory Studies

  • Parvovirus B19: The incubation period is 7-18 days, and the state of viremia lasts 5-6 days.
    • CBC count (to assess hemoglobin, neutrophils, lymphocytes)
    • High immunoglobulin M antibody levels 4-6 days after the initial viremia
    • Viral B19 DNA by polymerase chain reaction
    • Immunoglobulin G antibody titer (of little diagnostic significance)
    • Low-to-moderate titer values for rheumatoid factor, anti-DNA, antinuclear, and anticardiolipin antibodies possible in some patients
  • Hepatitis A virus
    • Elevated bilirubin and transaminases values
    • Immunoglobulin M–specific anti–hepatitis A virus
  • Hepatitis B virus
    • Elevated bilirubin and transaminases values (may be normal in early stage of disease when arthritis is present)
    • Serum hepatitis B surface antigen, hepatitis B early antigen, anti–hepatitis B surface antigen immunoglobulin M (indicates acute infection), viral DNA, polymerase
  • Hepatitis C virus
    • Elevated bilirubin and transaminase values (Normal transaminase levels do not exclude HCV infection.)
    • Anti-HCV
    • HCV-RNA by polymerase chain reaction methods
    • Cryoglobulins, rheumatoid factor
  • Rubella virus
    • Anti–rubella virus immunoglobulin M (peaks 8-21 d after symptoms, then wanes by 5 wk)
    • Anti–rubella virus immunoglobulin G (rises rapidly over a period of 1-3 wk and is of long duration)
    • More recently, rubella virus has been isolated from lymphocytes and synovial fluid of patients who had vaccine-induced disease or who experienced rubella virus–associated arthritis years earlier.
  • Alphaviruses: Diagnosis is confirmed by specific serology results.
  • Human immunodeficiency virus: Generally, laboratory abnormalities are common but nonspecific in persons with HIV infection.
    • Elevated levels of serum immunoglobulins, moderate elevation of erythrocyte sedimentation rate, circulating immune complexes, low-grade complement activation, low-titer antinuclear antibody, rheumatoid factor, false-positive test result for syphilis and anticardiolipin antibodies, and lupus anticoagulants
    • CD8+ T cell and P-24 antigen possibly detected in synovial fluid.
  • Human T-lymphotropic virus: HTLV-1 infection is diagnosed based on detection of antibodies with enzyme-linked immunosorbent assays, with confirmation by Western blot and the observation of "flower cells" on the peripheral smear.
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Imaging Studies

Radiologic findings depend on the condition. Most of the virus-associated arthropathies are nonerosive and show only soft-tissue swelling. However, with HIV-related seronegative or psoriatic-type arthropathy, erosions, ankylosis, narrowing of joint spaces, whittling, osteolytic lesions, periostitis, sacroiliac joint-space widening, and syndesmophyte formation can be seen.

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Procedures

Aspiration of the joint is useful to help rule out other conditions such as crystal arthropathy or bacterial 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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