Arthralgias and sometimes arthritis can be seen with a number of viruses, including parvovirus B19, acute hepatitis B, chronic hepatitis C, rubella (infection and vaccination), corona virus and alphaviruses. Joint complaints are described less commonly with many other viral infections, including EBV, CMV, herpesvirus, HIV, mumps, and enterovirus. With the exception of chronic hepatitis C, viral arthritis is usually self-limited, with resolution of symptoms within 3 months. A positive test for RF is commonly seen in chronic hepatitis C, especially if cryoglobulins are present, which can lead to a mistaken diagnosis of RA.
It is believed that viruses are able to initiate rheumatic symptoms through various mechanisms, including direct invasion of the joint, immune complex formation, or both.
The diagnosis of viral arthritis is possible if the patient’s presentation and exposure history suggest a recent viral illness. Most patients will have acute polyarthralgias or arthritis. The onset of the joint manifestations is most common in the prodrome or coincident with the clinical infection. Rashes are common. Serial serology can be used to confirm the presence of IgM antibodies or recent seroconversion. Identification of the virus in the joint fluid or tissue is typically not warranted, and, in many cases, will be negative even in the face of a serologically established infection.
Owing to the self-limited nature of these infections, treatment is supportive. NSAIDs are usually sufficient for the relief of symptoms. The arthropathy is not destructive and the prognosis is good. The arthritis of chronic hepatitis C may respond to treatment of the underlying viral infection.