Internal Medicine

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

1532 Viral Arthritis

■Rubella: flu-like illness; adenopathy; morbilliform rash; symmet-

ric polyarticular arthralgia & arthritis more commonly in women

than men; tenosynovitis, carpal tunnel syndrome, brachial neuritis

or lumbar radiculoneuropathy (in children)

■Alphaviruses: arthropod-borne; commonly w/ constitutional symp-

toms, rash & arthralgia or arthritis – symmetric polyarticular or

oligoarticular

■Other viruses assoc w/ joint involvement infrequently: mumps, ade-

novirus, CMV, EBV, HSV, varicella-zoster virus, coxsackieviruses,

echoviruses, hepatitis A, smallpox

tests

Basic Tests

■General lab tests usually nonspecific: leukocytosis & elevated ESR &

CRP possible

■Selected viruses may cause specific changes

➣Parvovirus B19: anemia, thrombocytopenia possible

➣Hepatitis B & C: elevated transaminases

➣Autoantibodies may be found w/ parvovirus B19 (ANA, RF, car-

diolipin, ds-DNA, Ro, La) or hepatitis C (ANA, RF)

■Synovial fluid findings variable: inflammatory or noninflammatory

Specific Diagnostic Tests

■Serologic tests for specific agents

➣Parvovirus B19: B19 IgM antibodies indicate current infection

➣Hepatitis B: HbsAg usually detectable at time of arthritis

➣Hepatitis C: positive anti-HCV antibody confirmed by qualitative

HCV RNA test

➣Rubella: IgM antibody or IgG seroconversion; culture from tissue

➣Alphaviruses: viral isolation or seroconversion

Imaging

■Imaging studies nonspecific: soft tissue swelling

differential diagnosis

■Inflammatory arthritis: early-onset connective tissue disease (eg, RA

or SLE, early seronegative spondyloarthropathy)

management

What to Do First

■Exclude other possibilities, esp. bacterial infection; must consider

new-onset connective tissue disease, RA or spondyloarthropathy