Virus | Epidemiology | Common clinical features | Diagnostic test |
---|---|---|---|
Parvovirus B19 | Exposure to young children | Large joint oligoarticular in children, RA-like pattern more common in adults. | B19 IgM |
Hepatitis B | Congenital transmission in high-risk countries MSM, IDU | RA-like pattern of arthritis lasting days to months with rash, malaise or myalgia. Joint symptoms often resolve with onset of jaundice. | HBsAg, anti-HBc, HBV DNA |
HCV | Worldwide MSM, IDU, blood transfusions | Mild RA-like pattern of arthritis/ arthralgia. | Anti-HCV, HCV-RNA |
HCV-associated cryoglobulinaemia | As above | Large joint oligoarticular non-erosive arthritis (often involving ankles). | Anti-HCV, HCV-RNA, cryoglobulins, low C4 |
HIV | Worldwide – especially sub-Saharan Africa, multiple sexual partners, MSM, IDU, blood transfusions | Variety of presentations reported. Joint symptoms as part of an immune-reconstitution syndrome also described with initiation of retroviral therapy. | Anti-HIV1/2, HIV-RNA |
Alphaviruses | Specific geographical range for each virus – See Fig 1 | Chronic arthritis/arthralgia associated with chikungunya infection, as well as tenosynovitis, carpal tunnel syndrome and new-onset Raynaud phenomenon. Associated thrombocytopenia common. | Specific-viral IgM, specific-viral RNA |
HTLV-1 | Japan, Caribbean | Chronic large and medium joint oligoarthritis. Fever myalgia and skin lesions common at onset of joint symptoms. Associated inflammatory eye, skin and muscle disorders reported. | Anti-HTLV-1, HTLV-1-DNA |
CHIKV = chikungunya; HBV = hepatitis B virus; HCV = hepatitis C virus; HTLV-1 = human T-lymphotrophic virus type-1; IDU = injecting drug user; MSM = men who have sex with men; RA = rheumatoid artritis.