Viral Arthritis Treatment & Management

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.

Surgical drainage is not indicated unless septic arthritis is considered likely. Most septic joints are managed effectively with a single surgical debridement. However, Hunter and colleagues reported that the risk factors for failure of a single surgical debridement included the following ^[14] :

• History of inflammatory arthropathy
• Involvement of a large joint
• Synovial fluid nucleated cell count of > 85.0 × 10 ⁹/L
• Infection with Staphylococcus aureus
• Diabetes mellitus

No dietary restrictions are necessary. Gentle mobilization may be initiated after a few days of rest.

In patients with rheumatoid arthritis (RA), the elevated risk of infection due to relative immunosuppression must be carefully assessed. ^[15] A better understanding of the cause of flareups would help predict patient responses to various therapies. ^[16]

Individuals with viral arthritis are usually treated in an outpatient setting. Order physical therapy as indicated. Follow-up care may be conducted by primary care physicians and rheumatologists. If the patient’s condition proves refractory, appropriate specialists can be consulted.

Preventive measures include the following:

• Vaccination
• Safe sex
• Clean food and drinking water
• Education

Parvovirus B19

Treatment of arthritis associated with parvovirus B19 infection is symptomatic, consisting primarily of administration of analgesics and NSAIDs. In severe cases, aspiration of fluid from the affected joint may relieve pain.

Hepatitis viruses

Treatment of arthritis associated with hepatitis A virus (HAV) is symptomatic, consisting primarily of administration of analgesics and NSAIDs. Prophylaxis for contacts is an important element of management.

No evidence indicates that early treatment of acute hepatitis B virus [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. Management of acute HBV infection should be focused on avoidance of further hepatic injury and prophylaxis of contacts.

For hepatitis C virus (HCV) infection, treatment continues  to evolve rapidly. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C contains the most recent recommendations of the American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (ISDA).

Rubella virus

Treatment of arthritis associated with rubella virus infection is symptomatic, consisting primarily of administration of analgesics and NSAIDs. Some investigators have recommended giving corticosteroids at low to moderate doses to control symptoms and viremia.

Alphaviruses

Treatment of arthritis associated with alphavirus infection is symptomatic, involving the use of analgesics and NSAIDs, but aspirin should be avoided so as to prevent the development of a hemorrhagic component with alphavirus rashes. When NSAIDs are not effective, chloroquine phosphate 250 mg/day may be considered.

Chronic chikungunya arthritis shares several characteristics with rheumatoid arthritis such as persistent debilitating arthralgia and exacerbated inflammatory response. Because of these parallels, hydroxychloroquine (HCQ) and disease‐modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX) and sulfasalazine have been evaluated in some peri‐epidemic clinical trials of treatments. However, these studies have produced conflicting outcomes and it remains unclear whether specific DMARDs are effective in treating chronic chikungunya arthritis. ^[17]

Retroviruses

For cases involving HIV infection, use currently recommended antiretroviral regimens, and treat symptoms with analgesics and NSAIDs. Administer sulfasalazine and methotrexate to patients who have 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, trimethoprim-sulfamethoxazole, and pentamidine help improve associated rheumatic symptoms. Intravenous immune globulin (IVIg), interleukin (IL)–12, IL-2, interferon gamma, or sargramostim may be effective in some HIV-infected patients with arthritis.

For human T-lymphotropic virus–1 (HTLV-1) infection, current treatment options are poor.

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