Joint pain is one of the most common complaints in the UK and US and its symptoms can be due to various different reasons. That is why it is important to characterize joint pain in seriously when it affects the same articulation on both sides of the body, asymmetric when it only affects one side, and mono-, oligo- and polyarticular depending on how many articulations it affects at the same time. All of these features give us further insight into what type of health problem we are dealing with.
There are many forms of arthritis. Some of them are autoimmune; others are mechanic and inflammatory, while others are infectious in nature.
They all lead to the destruction of the joint structures and may cause varying forms of disability. But is there a viral disease that attacks the joints? Given the resistance of viruses against antibiotics and other forms of therapy, how can you handle such a problem?
Joint problems and infectious disease
One distinct type of arthritis is called Septic arthritis, and it is caused by infectious agents. They can be either bacteria, viruses, or fungus. In these patients, there’s an invasion of the joint by microorganisms or an immune cross-reaction that destroys the joint surfaces.
The incidence of septic arthritis is near 8 cases per 100,000 people, and the majority of them are caused by a gonococcal infection. It is more common in patients with prosthetic joints, patients with immune problems, and older adults with acute infections.
Viral infections are not a common cause of septic arthritis, and even though it is a possibility, it is still very remote. But there are other causes of viral infections that attack the joints, and they are typicalled called “viral arthritis”.
Viruses associated with joint pain
Viral arthritis is a type of inflammation in the joint tissue that results from a viral infection. There are plenty of viruses that may cause this type of pain, and they should be diagnosed based on their clinical features and lab tests. The development of viral arthritis depends on the individual and how aggressive the virus is.
The majority of these viruses have a tropism for joint tissues, which means they circulate throughout the body but accumulate in the joints. The body starts creating immune complexes with antibodies to destroy the virus, but they miss their target and attack the joint tissue in the process. Other viruses would also damage the joint directly, causing physiologic alterations in bone homeostasis.
with thanks www.ncbi.nlm.nih.gov
The most common viruses that cause joint pain are as follows:
- Hepatitis virus: It is the primary cause of viral arthritis in most parts of the world. The most common hepatitis viruses are Hepatitis A virus (HAV) and Hepatitis B virus (HBV). The former causes 14% of cases of viral arthritis and the latter is responsible for up to 25% of cases. While HAV is transmitted by water and food contamination, HBV is transmitted sexually or after using blood products. They usually cause a skin rash along with arthritis that is very characteristic, and it is commonly diagnosed after a series of lab tests and clinical evaluations. Another type of hepatitis virus that causes viral arthritis is Hepatitis C virus (HCV), but it is far less common than the other two.
- Parvovirus: More specifically, parvovirus B19, which is responsible for around 12% of cases. This virus infects adults and children but causes polyarticular arthritis in adults mostly. Thus, it is more common in schoolteachers, pediatric nurses, and personnel who is in close contact with children. Parvovirus B19 infections are transmitted through respiratory secretions and blood products.
- Rubella virus: The incidence of rubella has dropped significantly after the introduction of the vaccine, but it causes joint problems after infecting humans. Rubella virus is more common in women than men, and it is transmitted via nasopharyngeal secretions.
- Retroviruses: The most important is HIV, which not only causes viral arthritis but many other forms of arthritis, including a higher risk of rheumatoid arthritis, psoriatic arthritis, systemic vasculitis, fibromyalgia, gout, and much more. Arthritis due to HIV starts at any given point of the infection. It is usually short in duration with recurrent episodes, but there are no erosive changes or deformation in the articulations. In some cases, joint pain will be associated with conjunctivitis, urethritis, skin rash, and other manifestations that guide the diagnosis.
- Alphaviruses: These viruses are different from the rest we have mentioned because its transmission depends on mosquito bites and not sexual intercourse or blood products. Among known alphaviruses, we can name the recent outbreak of chikungunya virus, the mayaro virus in South America, the Ross River virus in Australia and New Zealand, and many others. These viruses attack bone tissue, both directly and indirectly, altering the metabolism of bone formation and destruction, and leading to severe bone loss that results in dull musculoskeletal pain and localized joint pain.
- Other viruses: Many other viruses cause joint damage and pain, including the varicella-zoster virus, Epstein-Barr and cytomegalovirus infections, mumps virus, and herpes simplex virus.
Is there any medication we can use?
Ironically, the only medical treatment for viral arthritis cases applies to HIV patients, who can use antiretroviral medications along with analgesics to fight the virus and control the symptoms at the same time. Still, there’s no definite cure for HIV, and these patients may experience recurrent symptoms according to their viral load.
As for the rest of the viruses, there is no treatment, and all we can do is using symptomatic therapy. It is possible to treat symptoms by using NSAIDs and analgesics. In cases of Parvovirus B19 infections, it may be useful to aspirate fluid from the joint to relieve pain; in rubella, corticosteroids may also help control the symptoms, and in alphavirus infections some authors have described good results by using methotrexate, hydroxychloroquine, and similar drugs.
Marks, M., & Marks, J. L. (2016). Viral arthritis. Clinical Medicine, 16(2), 129-134.
Pattamapaspong, N., & Louthrenoo, W. (2011, November). Musculoskeletal infection in acquired immunodeficiency syndrome. In Seminars in musculoskeletal radiology (Vol. 15, No. 05, pp. 541-553). © Thieme Medical Publishers.
Alla, S. A. O., & Combe, B. (2011). Arthritis after infection with Chikungunya virus. Best Practice & Research Clinical Rheumatology, 25(3), 337-346.
Zaid, A., Gérardin, P., Taylor, A., Mostafavi, H., Malvy, D., & Mahalingam, S. (2018). Chikungunya arthritis: implications of acute and chronic inflammation mechanisms on disease management. Arthritis & Rheumatology, 70(4), 484-495.