VIRAL ARTHRITIS

BY

MOSES OGUNDARE
130704019
INTRODUCTION
 Viral arthritis is inflammation of the joints from a viral infection.
Approximately 1% of all cases of acute arthritis are thought to have a viral
etiology.

 Infection from a broad range of viruses can result in arthralgias and arthritis.
In some cases the specific virus involved can be identified on the basis of the
clinical features of systemic infection, but in many cases serologic testing is
necessary for diagnosis, guided by clinical and epidemiologic data.
INTRODUCTION CONT’D

 In general, viral arthritis is mild and requires only symptomatic

treatment with analgesics or nonsteroidal anti-inflammatory drugs
(or, occasionally, low-dose prednisone).

 In some cases, antiviral treatment is available for the underlying

systemic disease.
PATHOPHYSIOLOGY
 Viruses can cause infection or act as cofactors in the development of rheumatic
diseases. Viral infection depends on both host and viral factors. Key host
factors include age, sex, genetic background, infection history, and immune
response.

 Key viral factors include mode of host entry, tissue tropism, replication, effects
of cytokines, ability to establish persistent or latent viral infections, and
alterations of host antigens. Infected cells can undergo apoptosis (programmed
cell death).
PATHOPHYSIOLOGY CONT’D

 The immune complexes from an antibody response can be deposited at sites of

viral infection or in the synovium.

 Virus-induced autoimmunity, polyclonal B-cell activation, and

immunodeficiency may result in opportunistic infection, largely because of an
inability of the immune system to eliminate the virus (eg, HIV, human T-
lymphotropic virus [HTLV]-1, or hepatitis C virus [HCV]).

 Molecular mimicry may cause abnormal self-reactivity by altering immune

tolerance.
ETIOLOGY

 Viruses that can give rise to viral arthritis include the following:

 Parvovirus B19
 Hepatitis viruses ( hepatitis A virus [HAV], hepatitis B virus [HBV], and HCV)
 Rubella virus
 Alphaviruses and flaviviruses
 Retroviruses
 SARS-CoV-2 (COVID-19)
EPIDEMOIOLOGY

 Viral arthritis is known to occur worldwide, though its exact international

incidence and prevalence are unknown,. The rate of HBV infection is higher in
Asia (especially China [10% of the population]), the Mideast, and sub-Saharan
Africa. HCV infection rates are higher in Africa and Asia.

 Age-, sex-, and race-related demographics

 Viral infection rates may be higher in adults than in children or the reverse,
depending on the virus under consideration. HBV infection rates in childhood
may be as high as 5% annually in some parts of the world.
EPIDEMOIOLOGY CONT’D

 In adulthood, HBV is transmitted through sexual activity or needle exposures.

Children are more susceptible to infection with parvovirus B19 than adults
are, although they rarely experience arthritis. As many as 60% of adults have
serologic evidence of past parvovirus B19 infection.

 Parvovirus B19 infection is more common in women than in men. Whether HAV
or HCV has a predilection for either sex is unknown. Viral arthritis has no
recognized racial or ethnic predilection.
CLINICAL FEATURES

 As many as 70% of patients are asymptomatic

 A few may have flulike symptoms (eg, fever, headache, sore throat, cough,
anorexia, vomiting, diarrhea, or arthralgia)
 A bright red rash is typically noted, often characterized as having a “slapped-
cheek” appearance (see the images below)
 Joint symptoms are rare (5-10%)
 Myalgia is common
 Necrotizing vasculitis with cryoglobulinemia
 Polyarteritis nodosa may be associated with chronic HBV viremia
 Patients may have arthritis-dermatitis syndrome
Fig 1:Typical "slapped cheek" appearance wa (Walker-
Bone et al 2017)
CLINICAL FEATURES

 Rare clinical features include the following:

 Henoch-Schönlein purpura is rare but possible
 Thrombotic thrombocytopenic purpura is unlikely but may be present
 Polyarteritis nodosa is rare
 Granulomatosis with polyangiitis (Wegener granulomatosis) is possible but
rare
MEDICAL MANAGEMENT OF VIRAL ARTHRITIS
 Approach Considerations
 In general, viral arthritis is mild and requires only symptomatic treatment with
analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs). Occasionally, a brief
course of low-dose prednisone is used.

 Surgical drainage is not indicated unless septic arthritis is considered likely. Most
septic joints are managed effectively with a single surgical debridement. However,
Hunter and colleagues reported that the risk factors for failure of a single surgical
debridement included the following:

 History of inflammatory arthropathy

 Involvement of a large joint
 Synovial fluid nucleated cell count of > 85.0 × 10 9/L
 Infection with Staphylococcus aureus
 Diabetes mellitus
 No dietary restrictions are necessary. Gentle mobilization may be initiated after a
few days of rest.
MANAGEMENT CONT’D
 In patients with rheumatoid arthritis (RA), the elevated risk of infection due to
relative immunosuppression must be carefully assessed. A better understanding of
the cause of flareups would help predict patient responses to various therapies.

 Individuals with viral arthritis are usually treated in an outpatient setting. Order
physical therapy as indicated. Follow-up care may be conducted by primary care
physicians and rheumatologists. If the patient’s condition proves refractory,
appropriate specialists can be consulted.

 Preventive measures include the following:

 Vaccination
 Safe sex
 Clean food and drinking water
 Education
PHYSIOTHERAPY MANAGEMENT OF VIRAL
ARTHRITIS
 In most cases, viral arthritis symptoms will resolve quickly. Physiotherapy can
help if the symptoms linger or if assistance is needed in regaining joint
function.
 Means of treatment includes;
 use of hot or cold packs on the inflamed joints and rest.
 Strengthening exercises
 Hydrotherapy
 Cryotherapy (ice therapy)
 TENS
PHYSIOTHERAPY MANAGEMENT CONT’D

 Range of movement exercises

 Cardiovascular activities
 Electrotherapy including Megapulse/ Ultrasound
 Provision of specialist equipment to help around the home
 Splints to protect and support affected joints
 Pain control modalities
 Pacing advice
 Joint protection advice
PROGNOSIS

 Viral arthritis is generally mild and self-limited, typically lasting no longer

than a few weeks. There is no specific treatment for the arthritis; simple
symptomatic measures (eg, analgesics, nonsteroidal anti-inflammatory drugs
[NSAIDs], or, occasionally, low-dose prednisone) are sufficient

 The major morbidity of viral arthritis is joint dysfunction. Mortality depends

on the type of virus causing the arthritis and on the duration of infection.
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REFERENCES CONT’D

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