Diseases

Viral Arthritis

Viral arthritis is a type of arthritis caused by a viral infection. The disease comes on quickly, causing intense swelling and pain in the joints. It often goes away after several weeks, but it can sometimes persist for months.

Understanding Viral Arthritis

Symptoms

The onset of viral arthritis is acute, meaning that it tends to come on quickly. It can be intense and very painful.

Arthritis Symptoms

Viral arthritis usually causes inflammation of the small joints in the hands, wrists, ankles and elbows. This type of arthritis can “jump” from joint to joint. It usually affects joints on both sides of the body.

In people with viral arthritis, inflammation causes the joints to become swollen, stiff and painful. The affected joints can feel like they’re “on fire.”

Flu-Like Symptoms

The viral infection that triggers the arthritis may cause people to feel generally unwell, achy, tired and feverish. They may have a loss of appetite. This can feel a lot like having the flu.

In some cases, a widespread rash appears on the skin, which may be caused by the virus.

Diagnosis

Viral arthritis can be difficult to diagnose because the symptoms are similar to many other forms of arthritis. It is best diagnosed by a specialist who is very familiar with arthritic diseases (a rheumatologist).

A careful and complete history will be taken followed by a thorough physical examination.

You should tell your doctor if you’ve recently had a viral infection or if you have been in contact with others who are ill.  

Blood tests can be done to look for inflammation and help diagnose viral arthritis. However, a blood test alone is not enough to diagnose the disease.

If there is evidence of acute viral illness, tests to confirm the infection may be performed. There are several other tests that can help make a diagnosis:

  • Complete Blood Count (CBC) – some viruses can alter levels of red and white blood cells
  • Erythrocyte Sedimentation Rate (ESR) to look for systemic inflammation
  • C-Reactive Protein (CRP) to look for systemic inflammation
  • Aspartate Aminotransferace and Alanine Aminotransferace – Liver enzymes – (to look for signs of infection with hepatitis B or C)
  • Creatinine – A test of renal function as some viruses can affect the kidneys
  • Urinalysis – To look for protein or blood in the urine
  • Chest x-ray – if there are respiratory symptoms
  • Testing for specific viruses can also be done such as EBV, Parvo B19, Hepatitis B & C, and HIV.
  • Testing to rule out other causes of inflammatory arthritis such as a Rheumatoid Factor, Anti-Nuclear Antibodies, etc.

Causes

Viral arthritis typically appears during the early stages of the viral infection that triggers it.

The onset is usually dramatic – it comes on quickly and intensely. You might go to bed and be fine, and then wake up in the morning with very swollen, painful and stiff joints.

It’s not fully understood what causes some people to get viral arthritis while others do not. One theory is that people may be genetically predisposed to viral arthritis.

There are many infections that can cause viral arthritis. Some common examples are the Epstein-Barr virus that causes mononucleosis (“mono”), parvovirus B19 that causes fifths disease, and the hepatitis B and hepatitis C viruses. Arthritis can also be associated with HIV.

Viral arthritis can affect anyone, but it is more common in women and younger adults.

People who come into contact with viruses more often, such as those in contact with children, are more likely to get viral arthritis.

Treatments

The onset of viral arthritis can be very dramatic. Typically, a young and otherwise healthy person suddenly feels unwell and has intense joint pain and swelling. This can cause a lot of anxiety. The first thing is to not panic and take a deep breath.

If you have viral arthritis or think you may have it, your family doctor should refer you to a rheumatologist. A rheumatologist is a specialist who is an expert in treating arthritic diseases. This type of doctor is in the best position to help you manage your condition.

Here are some recommendations:

  • Learn as much as you can about this disease
  • Attend your doctor and/or rheumatologist appointments regularly
  • Take it easy
  • Learn about the medications used to treat viral arthritis. The RheumInfo website has tools to help you understand these medications and their impact on your disease

Treatment of Viral Arthritis

Viral arthritis is usually self-limiting, meaning it will go away on its own. Treatment is often targeted to controlling the symptoms and making you feel more comfortable. Fortunately, improvement is usually seen within 2 weeks, though it can take a few months before you feel back to normal.

Medications for Viral Arthritis

Treatment for the symptoms of viral arthritis often requires a combination of medications. During the acute attacks, corticosteroids can be very effective to control inflammation. These can be taken orally as pills (prednisone) or sometimes as cortisone injections directly into a joint. This type of treatment provides the quickest relief of the pain and swelling in joints affected by viral arthritis.

Non-Steroidal Anti-Inflammatory Drugs or NSAIDs are sometimes used to reduce joint inflammation caused by viral arthritis. They can also help to reduce pain. They may take a little longer to work than corticosteroids.

Simple analgesics (pain relievers) such as acetaminophen or paracetamol may be sufficient for managing the pain caused by viral arthritis. When non-prescription analgesics and NSAIDs are not enough to control the pain, stronger medicines called opioids may be used. These should be discussed with your doctor. While opioids can be very effective at controlling pain, they should be used with caution. These drugs can cause dependence and have been associated with drug abuse. Examples of opioids include codeine, morphine, and oxycodone.

Often, more than one type of medication is needed to control the pain and inflammation of viral arthritis.