Top viruses causing Arthritis
Viral arthritis is a form of joint inflammation caused by various viral infections. It often presents as acute or chronic arthritis or arthralgia, typically affecting multiple joints. Unlike autoimmune arthritis, viral arthritis is usually self-limiting, resolving as the viral infection subsides, although some cases may mimic inflammatory joint diseases like rheumatoid arthritis.
Viruses causing arthritis may do so via direct invasion of joint tissues or through immune-mediated mechanisms, such as immune complex deposition or molecular mimicry. Common viral culprits include Parvovirus B19, Hepatitis B and C, Chikungunya, Rubella, HIV, and Dengue.
The clinical presentation of viral arthritis varies widely depending on the causative virus, ranging from transient, mild joint pain to chronic, debilitating arthritis. While it is often diagnosed based on clinical history and serological tests, distinguishing viral arthritis from other inflammatory or infectious causes is crucial for appropriate management.
Causes of Virus-Induced Arthritis and Differentiating Points
Mnemonic: “Pretty Red Hands Have Chikungunya’s Dreadful Hurts”
- P: Parvovirus B19
- R: Rubella
- H: Hepatitis B
- H: Hepatitis C
- C: Chikungunya
- D: Dengue
- H: HIV
1. Parvovirus B19
- Key Features:
- Common in children and women.
- Symmetrical polyarthritis mimicking rheumatoid arthritis.
- Associated with erythema infectiosum (“slapped-cheek” rash).
- Diagnosis: IgM antibodies or PCR.
2. Rubella Virus
- Key Features:
- Post-infectious or after vaccination.
- Transient symmetrical arthritis.
- Often affects wrists and fingers.
- Diagnosis: History of recent rubella or vaccination; serology.
3. Hepatitis B Virus (HBV)
- Key Features:
- Acute arthritis, often migratory.
- Associated with urticaria or rash.
- Precedes jaundice in acute HBV.
- Diagnosis: HBsAg, HBcAb IgM.
4. Hepatitis C Virus (HCV)
- Key Features:
- Chronic polyarthritis resembling RA.
- Extra-articular manifestations (cryoglobulinemia, vasculitis).
- Diagnosis: Anti-HCV antibodies, PCR.
5. Chikungunya Virus
- Key Features:
- High fever with severe arthralgia/arthritis.
- Chronic arthritis can mimic inflammatory arthritis.
- Common in endemic areas.
- Diagnosis: Serology or PCR.
6. HIV
- Key Features:
- Arthropathy, often asymmetrical.
- Reactive arthritis or psoriatic arthritis phenotype.
- Diagnosis: HIV serology, CD4 counts.
7. Dengue Virus
- Key Features:
- Arthralgia with “breakbone fever.”
- Joint symptoms transient, rarely chronic.
- Diagnosis: NS1 antigen, IgM/IgG serology.
Differentiation at a Glance:
| Virus | Pattern of Arthritis | Other Key Features | Diagnostic Test |
|---|---|---|---|
| Parvovirus B19 | Symmetrical, RA-like | Slapped-cheek rash | IgM antibodies, PCR |
| Rubella | Symmetrical, transient | Post-vaccination; rash | Serology |
| Hepatitis B | Migratory | Rash, precedes jaundice | HBsAg, HBcAb IgM |
| Hepatitis C | RA-like, chronic | Cryoglobulinemia, vasculitis, Large joint oligoarticular non-erosive arthritis (often involving ankles). | Anti-HCV, PCR, cryoglobulins, low C4 |
| Chikungunya | Severe, chronic, debilitating | High fever, fever and severe joint pain, which is often debilitating and varies in duration; other symptoms include joint swelling, muscle pain, headache, nausea, fatigue and rash | Serology, PCR |
| Dengue | Transient | Breakbone fever | NS1 antigen, IgM/IgG |
| HIV | Asymmetrical | Reactive/psoriatic arthritis | HIV serology, CD4 count |
Less Common Causes of Viral Arthritis: Table with Differentiating Features
Mnemonic: “Every Careful Zebra Makes Amazing Adventures Hunting Sindbis”
- E: Epstein-Barr Virus (EBV)
- C: Cytomegalovirus (CMV)
- Z: Zika Virus
- M: Mumps Virus
- A: Alpha Viruses (Mayaro, Ross River)
- A: Adenovirus
- H: HTLV-1
- S: Sindbis Virus
| Virus | Key Features | Mechanism | Diagnosis |
|---|---|---|---|
| Epstein-Barr Virus (EBV) | Fatigue, lymphadenopathy, arthralgia > arthritis | Immune complex-mediated | EBV serology (VCA-IgM, EBNA) |
| Cytomegalovirus (CMV) | Arthropathy in immunocompromised patients | Immune-mediated | CMV PCR or serology |
| Varicella-Zoster Virus (VZV) | Arthritis with reactivation (herpes zoster) | Immune complex or direct invasion | PCR or serology |
| Zika Virus | Arthralgia, rash, conjunctivitis | Immune-mediated | RT-PCR or serology |
| Mumps Virus | Mono-/polyarthritis, associated with parotitis | Immune complex deposition | Clinical history, serology |
| Alpha Viruses (Mayaro, Ross River) | Severe joint pain, rash, endemic areas | Direct viral replication, immune-mediated | PCR or serology |
| Adenovirus | Arthritis in children, post-respiratory infection | Immune-mediated | PCR or culture |
| HTLV-1 | Chronic seronegative inflammatory arthritis | Direct viral and immune effects | HTLV-1 antibodies |
| Sindbis Virus | Arthralgia with rash, endemic areas | Immune-mediated | PCR or serology |
In conclusion, viral arthritis presents diverse clinical features, often mimicking other inflammatory joint diseases, making an accurate diagnosis crucial. I hope this article will help diagnose the causes of arthritis secondary to viruses.
