What is Viral Arthritis?
Sudden arthritis affecting many joints is usually the primary sign of viral arthritis. Viruses like parvovirus, the alphaviruses, hepatitis B and C, Epstein-Barr virus (EBV), as well as tropical viruses like Zika and chikungunya (CHIKV) are often responsible for causing arthritis or joint pain. Identifying this condition can be tricky but should always be considered when someone experiences sudden symptoms in multiple joints.
Even though viruses are responsible for a minor percentage of all sudden arthritis cases, it’s vital to differentiate between arthritis caused by viruses and arthritis resulting from primary rheumatological diseases. Autoantibodies, which are antibodies that attack a person’s own tissues, like the rheumatoid factor and antinuclear antibody, can sometimes be present during a case of acute viral arthritis. These autoantibodies can be detected in a low amount.
In general, the severity of viral arthritis is less than other types such as osteoarthritis or rheumatoid arthritis. The majority of patients find relief from Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), and it is rare that antiviral treatment is necessary.
What Causes Viral Arthritis?
Several viruses can cause a condition known as viral arthritis. The most common ones include Parvovirus, alphavirus, rubella, Hepatitis B, C, and flavivirus. However, other viruses like EBV, HIV, mumps, herpes, and cytomegalovirus (CMV) can also cause arthritis (joint inflammation) or arthralgia (joint pain) in rare cases.
Recently, cases of arthritis linked to mosquito-borne viruses like Zika and CHIKV have increased. Sometimes, the virus causing arthritis might depend on other health conditions a patient might have. For instance, a patient on medications that suppress the immune system might get viral arthritis from the EBV virus.
Arthritis caused by HIV is more common than once thought. Up to 30% of HIV patients may have arthritis as the first sign of their HIV condition. However, it can happen at any stage of the illness. These patients are not at risk of getting a severe joint infection, but they may get a rare infection of the muscles known as pyomyositis. Some patients might also develop reactive arthritis, a condition where the body reacts to an infection in another part of the body by causing inflammation in the joints. Some might even develop psoriatic arthritis, a type of arthritis that affects some people with psoriasis, a skin condition.
Risk Factors and Frequency for Viral Arthritis
Viral arthritis is a condition that can occur anywhere in the world, but we don’t know exactly how common it is. This is because many different viruses can cause it, it occurs in different places at different rates, and often, the illness goes away on its own. Adults typically have higher rates of viral arthritis than children. While children can get a virus called parvovirus B19, they rarely experience arthritis from it.
Signs and Symptoms of Viral Arthritis
Viral arthritis symptoms vary depending on the specific virus causing the infection. Typically, people with viral arthritis experience a temporary (self-limiting) episode of symmetrical joint pain or inflammation in multiple joints. Monoarthritis, or inflammation in just one joint, is fairly rare. Other symptoms may include fever, rash, and swollen lymph nodes. It’s also possible for viral arthritis to closely resemble rheumatic diseases like rheumatoid arthritis, especially since these conditions can sometimes be related to the presence of autoantibodies, like the rheumatoid factor (RF) and antinuclear antibody (ANA). However, these levels are usually low and decline quickly. Some viruses, like Chikungunya, can lead to recurring or even chronic arthritis. Nonetheless, most of these infections improve on their own, typically within 6 to 12 weeks.
- Simultaneous joint pain or inflammation in multiple joints
- Fever
- Rash
- Swollen lymph nodes
- Conditions mimicking rheumatic diseases such as rheumatoid arthritis
- Presence of autoantibodies like RF and ANA (usually at low and temporary levels)
- Possible recurring or chronic arthritis (in cases with viruses like Chikungunya)
- Most infections improve on their own within 6 to 12 weeks
Testing for Viral Arthritis
Parvovirus B-19 is a virus commonly associated with “fifth disease,” a condition that can cause joint pain and inflammation in both children and adults. It could be mistaken for rheumatoid arthritis (RA) due to its similar symptoms. Diagnosing an active parvovirus infection involves finding antibodies, which are proteins that the body makes in response to the virus, in the bloodstream. This joint inflammation tends to go away on its own after a few weeks.
Hepatitis A, B, and C are viruses that can also cause joint pain, but it’s rare for them to cause inflammation of the joints. However, in patients with hepatitis B and C, around 10-25% can show symptoms of joint inflammation. This is due to the formation of immune complexes, a group of proteins that cause inflammation in the body. Notably, with Hepatitis B, the joint inflammation often goes away with the onset of jaundice, a yellowish discoloration of the skin and eyes.
HIV, the virus that causes AIDS, can also cause various joint-related issues. However, the occurrence of these conditions has significantly decreased with the advent of highly active antiretroviral therapy (HAART), a powerful treatment regimen for HIV.
Epstein-Barr viral infection is often accompanied by joint pains, but actual joint inflammation is rare. The joint symptoms are temporary and treatment usually involves managing the symptoms. Alphaviruses, which are transmitted through mosquito bites, can cause feverish joint pains and inflammation.
Dengue and Zika virus, members of the Flavivirus group, can also cause fever-like illnesses and symptoms of joint pain and swelling. Other viruses such as mumps, HTLV-1, rubella, and some types of enterovirus can cause joint pains and inflammation as well.
Diagnosing viral joint inflammation largely depends on clinical symptoms, backed up with tests such as measures of inflammation, autoantibodies, and virus-specific tests. If a patient presents with acute onset of joint pains or inflammation over a period of less than six weeks, a viral cause might be suspected. In these suspected cases, blood is typically collected for testing. Other lab tests could also provide important clues to the diagnosis, but such tests need to be directed specifically at the suspected viruses.
Treatment Options for Viral Arthritis
Treatment for viral arthritis mainly involves managing symptoms like pain and inflammation. Medications like NSAIDs (non-steroidal anti-inflammatory drugs) and acetaminophen, also known as paracetamol, are commonly used for this purpose. Steroid medications, often referred to as corticosteroids, generally aren’t recommended for treating viral arthritis. For certain types of viral arthritis such as those related to Hepatitis B/C or HIV, using antiviral medication could potentially resolve the joint symptoms.
What else can Viral Arthritis be?
Here are some medical conditions that may present with similar symptoms:
- Lupus
- Psoriasis
- Lyme
- Gonorrhea
- Rheumatoid arthritis
- Osteoarthritis
- Ankylosing spondylitis
What to expect with Viral Arthritis
Viral arthritis is generally a mild condition and doesn’t last for very long in most individuals. There isn’t a specific treatment for it and recovery typically occurs within a few weeks. The impact on joint function is short-term and doesn’t lead to any long-term issues.
