Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

Viral Arthritis 1533

■Symptomatic treatment: NSAIDs for the inflammatory symptoms,

acetaminophen or other analgesics may be needed

General Measures

■Long-term therapy usually not needed as these conditions are gen-

erally self-limited, lasting for days to a few weeks

■Chronic arthropathy may require corticosteroids

specific therapy

Indications

■Joint pain & swelling; systemic symptoms

Treatment Options

■Symptomatic therapy: NSAIDs, occasionally low-dose prednisone or

hydroxychloroquine for more persistent joint inflammation

■Interferon & ribaviron used for hepatitis C; no specific antiviral ther-

apy available for other infections

■IVIg reported for persistent parvovirus B19 infection in immuno-

compromised hosts

Side Effects & Complications

■NSAID complications: GI bleeding & pain, renal insufficiency,

platelet inhibition

■Prednisone: osteoporosis, immunosuppression

■Contraindications

➣Usual contraindications to use of NSAIDs or prednisone

follow-up

During Treatment

■Follow-up should document resolution of symptoms & permit dis-

continuation of therapy

Routine

■Recurrent episodes of arthritis reported, esp. w/ parvovirus B19

complications & prognosis

■Viral arthritis is generally self-limited w/ a good long-term prognosis

■Chronic arthropathy occurs occasionally following parvovirus B19

infection, at times w/ positive RF, raising question of the relationship

of infection to RA