Arthritis associated with viral infection

Viral infections are a widespread cause of acute or prolonged arthritis, often accompanied by fever, skin rashes, and general symptoms. Although current knowledge about the pathogenesis of virus-associated arthritis has a number of gaps, it is believed that these diseases develop as a result of several complementary mechanisms, including direct viral exposure, immunocomplex inflammation, induction of proinflammatory cytokine synthesis, and the development or intensification of autoimmune disorders through a number of mechanisms, including molecular mimicry, bystander activation, or epitope spreading. Some of the viral arthritis induced, for example, by parvovirus B19, rubella virus, hepatitis B, and SARS-CoV-2, can mimic early rheumatoid arthritis, but are treated without consequences within a few weeks in the absence of specific therapy. Others, such as tropical alphaviruses, are more likely to lead to prolonged, respectively, chronic arthritis, which at the moment in temperate latitudes may pose a major diagnostic problem for tourists who have fallen ill and returned to their homeland. Arthritis or arthralgia is the main clinical symptom indicating a serious infection of an epidemic nature (for example, alpha-virus-induced arthritis, HIV-associated arthritis). In view of the above, rheumatologists (as well as clinicians of other specialties) should remain vigilant about the viral etiology of acute arthritis. At the same time, it is very important to distinguish between virus-mediated arthritis and systemic rheumatic disease in a timely manner, since the latter may require the early appointment of specific diseasemodifying drugs. This review presents the main characteristics of the most common viruses and the features of damage to the musculoskeletal system in these infections.

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