Which retroviruses cause viral arthritis?

Updated: Nov 12, 2019
  • Author: Rabea Ahmed Khouqeer, MD, FRCPC, FAAAAI; Chief Editor: Herbert S Diamond, MD  more...
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Answer

HIV infection is associated with several rheumatic manifestations, of which arthralgia is the most common (25-40% of cases). [8] Other manifestations include the following:

Arthritis (ie, arthralgia and arthritic syndromes) in association with HIV infection has been reported in the United States, Europe, and Africa. It can occur at any stage of HIV infection. The pattern of HIV-associated arthritis is similar to that of arthritis associated with other viral disorders: acute onset, short duration, recurrences, and no erosive changes. Patients infected with HIV are not at increased risk for the development of septic arthritis but they do have an increased frequency of pyomyositis.

Diffuse infiltrative lymphocytosis syndrome (DILS) resembles Sjögren syndrome, with sicca symptoms, salivary gland enlargement, and lymphocytic infiltration involving the lungs, gastrointestinal (GI) tract, and kidneys. To make the diagnosis, there needs to be histological confirmation of salivary or lacrimal lymphocytic infiltration, with granulomatous or neoplastic etiologies excluded. In contrast to Sjögren syndrome, the lymphocytes infiltrating these sites in diffuse infiltrative lymphocytosis syndrome are predominantly CD8+ (rather than CD4+) T cells and the presence of elevated titers of circulating and infiltrating CD8+ lymphocytes is a key feature of the pathophysiology. [9]

Reactive arthritis in association with HIV infection occurs in 0.5-3% of cases. Oligoarthritis of the lower extremities and urethritis is common, but conjunctivitis is rare. Severe erosive arthritis is possible and can be very debilitating.  Human leukocyte antigen (HLA)–B27 is found in 80–90 % of Caucasians with HIV-associated reactive arthritis, while studies of Africans with HIV-associated reactive arthritis have found nearly all to be HLA-B27-negative. As in HIV-uninfected patients, antecedent history of genitourinary and gastrointestinal infection is common. This point could hold the key to explaining the geographical differences observed in the prevalence of reactive arthritis – countries with higher rates of HIV contracted through intravenous drug use for example, rather than sexual contact, have observed lower rates of reactive arthritis. [10]

Psoriasis and psoriatic arthritis tend to occur late in the course of HIV infection. They are often severe.

Human T-cell lymphotropic virus – 1 (HTLV-1) is a type C retrovirus (an RNA virus in the Oncovirinae subfamily) that infects millions of people worldwide, particularly in the Caribbean, southern Japan, South Africa, and South America. It is transmitted through ingestion of breast milk, sexual intercourse, and use of blood products. HTLV-1 infection is associated with Sjögren syndrome, as well as with the following diseases:

  • Adult T-cell leukemia/non-Hodgkin lymphoma (lifetime risk, 5%) – These are commonly associated with hypercalcemia and skin involvement

  • Chronic inflammatory syndromes (lifetime risk, 2%) These include a seronegative oligoarthritis or polyarthritis with tenosynovitis and nodules with fibrinoid necrosis; other syndromes include polymyositislike disease, dermatitis, uveitis, and transverse myelitis (known as tropical spastic paraparesis)


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