Viral Arthritis - Causes, Clinical Diagnosis, Investigations, and Treatment

What Is Viral Arthritis?

Viral arthritis is the swelling or inflammation of one or more joints caused by a viral infection. Acute-onset arthritis is a common clinical condition for both general practitioners and rheumatologists. Approximately one percent of all episodes of acute arthritis are caused by a viral infection.

What Causes Viral Arthritis?

• Most Frequent:

  • Parvovirus.

  • Alphavirus.

  • Rubella.

  • Hepatitis B and hepatitis C.

  • Flavivirus.

• Mosquito-Borne Viruses:

  • Zika.

  • Chikungunya virus (CHIKV).

• Other Viruses:

  • Epstein-Barr virus (EBV).

  • Human immunodeficiency virus (HIV).

  • Mumps.

  • Herpes.

  • Cytomegalovirus (CMV).

• Viral Arthritis and Patients With Comorbidities:

  • EBV can cause viral arthritis in immunosuppressed people.

  • HIV-related arthritis is the first symptom in at least 30 percent of HIV patients at any point in the virus's life cycle.

• Viruses That Cause Viral Arthritis Are:

  • Parvovirus B-19: Parvovirus B-19, commonly known as the ‘fifth disease’ or erythema infectiosum, can cause arthritis and arthralgia (joint pain) in both children and adults. Up to 60 percent of adults who are infected experience joint problems. The skin eruption may be accompanied by or followed by arthritis or arthralgias. However, adult rashes are less frequent. A prevalent pattern in adults includes proximal interphalangeal and metacarpophalangeal joints (finger and hand joints), most usually affected by acute symmetrical polyarticular arthritis mimicking rheumatoid arthritis (RA). Finding circulating IgM (immunoglobulin M) parvovirus antibodies allows for the identification of acute parvovirus infection. IgG antibodies have been detected in a significant number of healthy persons as well as those who may have a prior infection. Arthritis caused by B19 typically goes away on its own within a few weeks.

  • Hepatitis Viruses: Though it rarely results in arthritis, hepatitis A occasionally might induce arthralgias. The hepatitis B (HBV) and hepatitis C (HCV) viruses can both lead to arthralgia and arthritis. Between 10 and 25 percent of HBV patients experience arthralgia and arthritic symptoms. The rapidly progressive stage is when the arthritic symptoms typically appear, and they may not be accompanied by any other clinical signs of hepatitis. Fever and rash may offer hints as to the underlying condition. The remission of HBV-related arthritis with jaundice is one of its distinguishing characteristics. Rarely, polyarteritis nodosa (inflammatory blood vessels) caused by HBV might also present with arthritis. In hepatitis C patients with arthritis, immune complex production and retention are also thought to be the pathophysiologic process.

  • HIV (Human Immunodeficiency Virus): The HIV-associated arthritis syndromes cover a wide range of conditions, including psoriatic arthritis, septic arthritis, reactive arthritis, HIV-associated arthritis, and infrequently reported painful articular syndrome. Since the advent of highly active antiretroviral therapy (HAART), the prevalence of various arthritic disorders has drastically decreased. Immune reconstitution inflammatory syndrome (IRIS), which occasionally reveals underlying rheumatological problems, has been observed to be precipitated by the start of HAART.

  • EBV (Epstein-Barr virus): The most frequent joint symptom of Epstein-Barr virus infection is arthralgia; however, arthritis is an uncommon condition that can occasionally cause significant joint swelling. Joint clinical manifestations are self-limiting, and symptomatic therapy is used. Although a triggering role in the onset of chronic inflammatory arthritis in RA has been suggested, no conclusive proof has been discovered.

What Is Viral Arthritis in Children?

Children are most commonly affected by viral infections, which can cause arthritis during or after a free interval of two to four weeks.

• Common Site: Joints of the lower limbs (ankles and knees).

• Symptoms: Articular symptoms in true infectious arthritis.

• Diagnosis: Viruses rubella, varicella-zoster, herpes, CMV, and others can be isolated from synovial fluid. The presence of their antigen-antibody type immune complexes in the synovial fluid with different viral infections suggests post-viral arthritis in children.

• Management: With symptomatic treatment, postinfectious arthritis has a good prognosis; recovery takes only a few weeks (approximately six weeks).

What Is Meant by Migratory Arthritis?

In the case of migratory arthritis, the pain of the arthritis migrates from one joint to another. Individuals affected by migratory arthritis exhibit symptoms of pain shifting between joints. The main cause of migratory arthritis is underlying health conditions such as fever, lupus (an autoimmune condition where the immune system attacks the body’s tissues and organs), inflammatory bowel conditions, and more.

What Are the Symptoms of Viral Arthritis?

The self-limited episode of symmetric polyarticular arthritis or arthralgia, fever, rash, and lymphadenopathy (swollen lymph node) are the common symptoms of viral arthritis. The symptoms may also vary based on the type of virus infection. Some people usually get affected due to mosquito bites. This is mostly caused by the Chikungunya virus, which causes symptoms in three to seven days after the bite of an infected mosquito. The usual symptoms and signs are fever, rashes, and joint pain.

How to Diagnose Viral Arthritis?

• Clinical Diagnosis: The collection of clinical manifestations that characterize viral arthritis appears to be connected to the particular virus that is infecting the patient. These patients typically experience an episode of symmetrical polyarthritis or arthralgia that resolves on its own. Fever, a rash, and lymphadenopathy could be present. Rheumatoid factor (RF) and antinuclear antibody (ANA) are two autoantibodies that may be present in certain viral arthritis syndromes, which can mimic the symptoms of rheumatoid arthritis in rare situations. The titers are often small and short-lived. Most of these infections in viral arthritis are self-limiting for less than six to 12 weeks. Viruses like Chikungunya are known for causing recurrent and frequently chronic arthritis.

• Laboratory Tests: Viral arthritis can be confirmed in various ways, such as inflammatory markers, autoantibodies, and serology.

• Serology Testing: To identify the type of virus.

• IgM Antibody Response: Acute infection (within six weeks).

• IgG Isotype: Chronic infection (after six weeks).

How Viral Arthritis Are Treated?

Symptomatic treatment is used when viral arthritis has been present for less than six weeks. The basis of treatment is NSAIDs (nonsteroidal anti-inflammatory drugs). Low-dose corticosteroids should only be used if NSAIDs cannot be prescribed. If the person is affected with hepatitis B, C, or HIV, then they can be treated using anti-viral medications.

How Long Does Viral Arthritis Last?

Depending on the type of viral infection, viral arthritis can last from days to weeks. Rarely can it become a chronic condition like hepatitis.

How Does One Get Rheumatoid Arthritis From a Viral Infection?

Viruses such as parvovirus and EBV may cause rheumatoid arthritis. RA is characterized by early morning stiffness of joints, inflammation of joints in three or more regions, and the presence of arthralgia for more than six weeks. RA can also be confirmed with the presence of RA factor and ANA.

How to Prevent Viral Arthritis?

By protecting the person from viral infection, the occurrence of viral arthritis can be prevented. To do this:

• One should avoid injecting drugs or medicine through needles unless instructed by the doctor.

• The person should consume clean drinking water.

• Should complete all the vaccinations recommended by the doctor.

• Condoms should be used during sex.

• The person should prevent mosquito bites.

Conclusion:

Understanding that many of these viral arthritis diseases are linked to increased levels of inflammatory markers is important. The titers for these markers are often modest and temporary, as repeatedly stated. A referral to a rheumatologist might be wise if the arthralgia and joint swelling persist or get worse, even though many of these cases may be treated in a primary care setting.