Internal Medicine

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

Ventricular Tachycardia Viral Arthritis 1531

complications and prognosis

■Survival related to underlying diseases and improved with ICD

therapy

■Best prognosis for idiopathic right or left ventricular tachycardia

■ICD: same as for pacemaker. Inappropriate shocks.

VIRAL ARTHRITIS

STEVEN R. YTTERBERG, MD

history & physical

History

■Exposure to specific infectious agents

■Dependent on individual viruses

➣Parvovirus B19: children w/ fifth disease

➣Hepatitis B: IV drug use, sexual transmission

➣Hepatitis C: IV drug use

➣Rubella: infected individuals, postvaccination

➣Alphaviruses: mosquito-borne, in endemic areas

➣HIV infection often causes joint pain, occasionally an oligoarthri-

tis involving lower extremities; self-limited

Risk Factors

■Exposure to specific viral infections, esp. being in an endemic area

■No known genetic factors

■Immunocompromised conditions

Signs & Symptoms

■Presentation depends on individual virus; symmetric polyarticular

arthralgias or arthritis most common, some pts w/ oligoarticular or

monoarticular

■Parvovirus B19: flu-like illness; typical “slapped cheeks” & fine retic-

ular rashes in children, mild maculopapular rash in adults; arthralgia

& arthritis in up to 80% of adult women, less common in men; sym-

metric polyaarticular joint involvement of small & large joints

■Hepatitis B: symmetric or migratory polyarticular arthritis often w/

rash during prodromal, preicteric phase of hepatitis; often improves

w/ onset of jaundice

■Hepatitis C: often assoc w/ cryoglobulinemia–arthritis & palpable

purpura; some pts w/ arthralgias or arthritis w/o cryoglobulins