Viral Arthritis - Diagnosis

Laboratory studies:Parvovirus B19-incubation period of 7-18 days, and viremia 5-6 days:Evaluate the hemoglobin, neutrophils, lymphocytesHigh-level IgM antibody lasts 4-6 days after initial viremiaHighlights the B19 DNA polymerase chain-IgG titer-Rheumatoid factor, anti-DNA antibodies, antinuclear, anticardiolipin.Hepatitis A:High and increased ALT, bilirubin-Specific IgM.Hepatitis B:Elevated transaminases, bilirubin and- Evaluation of surface antigen, polymerase chain reaction, IgM.Hepatitis C:High-transaminase and bilirubin, HCV antibodiesPolymerase chain-reaction, and rheumatoid factor crioglobulinei assessment.Rubella:Heaped-rubella immunoglobulin M from 8 to 21 days after symptomsRubella-immunoglobulin G increases rapidly after 1-3 weeks and persists for 5 weeks-Isolation of virus from synovial fluid lymphocytes.HIV infection:High-immunoglobulins, erythrocyte sedimentation rate increased-Circulating immune complexes, complement activation moderateModerate-titer antinuclear antibodies, rheumatoid factorFalse positive test for syphilis, anticardiolipin antibodies and lupus anticoagulantsCD8-cells and p24 antigen detected in synovial fluid.
Imaging Studies:X-rays depends on the condition. Most arthropathy associated viruses are non-erosive and have only soft tissue swelling. HIV associated arthropathy are recognized in erosive arthritis, psoriatic ankylosis, joint space collapse, osteolytic lesions, periostitis, and sacroiliac joint space widening sindesmofite training.
Joint aspiration is useful to exclude conditions such as bacterial infection or crystal arthropathy.
The differential diagnosis is made with the following conditions: acute rheumatism, ankylosing spondylitis, undifferentiated spondyloarthropathies, aplastic anemia, cryoglobulinemia, Lyme disease, polymyositis, psoriatic arthritis, rheumatoid arthritis, Sjogren syndrome, systemic lupus.