What Is Viral Arthritis?

Introduction to viral arthritis

Viral arthritis, or post-viral arthritis, is defined as inflammation in one or more joints caused by a viral infection.¹ 

Viruses are very small organisms that infect cells. Many different types of viruses can infect human cells. Viruses are responsible for a wide range of symptoms, and viral arthritis is one such symptom. Viral arthritis is acute, meaning the associated joint inflammation comes on suddenly and can be severe. The four main features of severe joint inflammation are localised redness, heat, swelling, and pain in the affected areas. 

Viral infection is a rare cause of acute onset arthritis and is estimated to be responsible for only 1% of all cases of it.²

Viral arthritis is not a long-term, chronic condition (unlike rheumatoid arthritis or osteoarthritis); the symptoms often resolve once the viral infection has cleared. During the viral infection, the symptoms can usually be managed successfully with non-steroidal anti-inflammatory drugs (NSAIDs), with antiviral medications rarely being required.¹

It is important that if you do experience sudden, severe joint pain, you get in touch with your healthcare provider so that they can identify the underlying cause and give you the most appropriate treatment.

What are the causes of viral arthritis?

Scientists have identified a range of viruses that can cause viral arthritis in humans. The likelihood that you develop viral arthritis and the duration of the arthritis-associated symptoms depends on the type of virus you are infected with.¹

The viruses associated with viral arthritis

The viruses that most commonly cause viral arthritis include: 

• Ross river virus
• Rubella(viral arthritis may also occur in some people after receiving the rubella vaccine)
• Parvovirus B19
• Hepatitis C
• Hepatitis B

There are also viruses that are known to cause viral arthritis, but much less commonly; these include:

• Epstein-Barr Virus
• Herpes Viruses
• Adenovirus
• Enterovirus
• Hepatitis A
• Human Immunodeficiency Virus (HIV)
• Mumps³

What are the clinical presentations and symptoms of viral arthritis?

Joint symptoms

If you have viral arthritis, one or more of your joints will be inflamed. An inflamed joint is painful, warm to the touch, and may look noticeably swollen and red compared to a normal joint. The range of motion in the joint may also be reduced (with a feeling of stiffness and restriction in the joint).¹

Systemic symptoms

Viral arthritis is itself a symptom of a viral infection. The type of viral infection causing the arthritis that you have dictates the other accompanying symptoms that occur alongside the viral arthritis. Listed below are the main symptoms of viral infections that are known to cause viral arthritis:

• Ross River virus: joint and muscle pain, rash, and fever
• Rubella: rash that starts on the face and then spreads to the rest of the body 
• Parvovirus B19: fever and joint pain
• Hepatitis B: general malaise (general feeling of illness), rash, and jaundice
• Hepatitis C: general malaise and jaundice
• Epstein-Barr virus: sore throat, swollen lymph nodes in the neck
• Herpes viruses: glandular fever, chicken pox/shingles, or mouth sores and ulcers
• Adenovirus and enterovirus: upper respiratory tract infections, gastrointestinal upset, and conjunctivitis
• Hepatitis A: flu-like illness and jaundice
• HIV: fever, sore throat, and swollen lymph nodes in the neck
• Mumps: swollen salivary glands (which look like swollen cheeks) and swollen lymph nodes ³

How long will the symptoms last?

The duration of viral arthritis will depend on the severity of the viral infection and can vary from days to weeks or even months. Viral arthritis will usually resolve with the eradication of the viral infection.³

How is viral arthritis diagnosed?

Clinical evaluation

If you go to your healthcare provider with severe joint pain that came on suddenly, they will carry out a full physical examination and assess your medical history. They will ask about any other symptoms you have had alongside the joint pain. They may also enquire about your recent travel history because some viral infections that cause viral arthritis are more common in specific geographic locations. Viral arthritis is difficult to diagnose because there is no single set of clinical symptoms observable that is indicative of viral arthritis. Therefore, the combined results of several supporting tests may be needed to confirm the diagnosis.⁴

Laboratory tests

The laboratory tests that are used to confirm a diagnosis of viral arthritis will look at inflammatory markers, autoantibodies, and the presence of specific viral markers. These are known as serological tests, and their results will indicate to your healthcare team whether other diagnoses need to be considered as joint inflammation can be a symptom of a wide variety of conditions.¹

How is viral arthritis distinguished from other diagnoses?

If joint inflammation has persisted for more than 6 weeks, or the diagnostic tests have come back negative or inconclusive for viral arthritis, your healthcare provider will investigate other possible causes of arthritis.⁵ Conditions that also may cause a sudden onset of severe joint pain include:

• Lupus
• Psoriasis
• Lyme disease
• Gonorrhoea
• Rheumatoid Arthritis
• Osteoarthritis
• Ankylosing Spondylitis ¹

How is viral arthritis treated and managed?

Viral arthritis will usually resolve without medical intervention. However, medication such as NSAIDs can be prescribed to manage your pain and inflammation while the viral infection is being fought off by your immune system. In the case of some viral infections, such as Hepatitis B/C or HIV, antiviral treatment will be given, and these treatments can help the resolution of joint pain and inflammation without the need for NSAIDs.¹

What is the prognosis and recovery for viral arthritis?

The length of time you might experience viral arthritis depends on the specific virus you are infected with, the severity of your infection, and when you access treatment. In most people, viral arthritis is mild and complete recovery takes a few weeks. Once recovered, viral arthritis usually has no remaining effects on your joint function.¹

How can I prevent or reduce my risk of viral arthritis?

The viral infections that cause joint inflammation are contagious, although the arthritis itself is not. Therefore, it reduces your risk of getting a viral infection and viral arthritis. You can reduce your risk of viral infection by:

• Getting all appropriate vaccinations, such as the measles, mumps, and rubella vaccine (MMR)
• Maintaining good hygiene practices such as washing hands and drinking clean water.
• Practising safe sex
• Preventing mosquito bites
• Avoiding geographic regions where there are local outbreaks of viral diseases such as Chikungunya and Zika virus⁶ 

Summary

Viral arthritis is a rare cause of sudden onset, severe joint pain and inflammation. Viral arthritis is caused by a range of different types of viruses. In most cases, viral arthritis resolves completely without medical intervention in a few weeks at most. Unlike rheumatoid arthritis or osteoarthritis, there are no long-term consequences of viral arthritis.

 It is important that you get checked by your healthcare provider if you experience joint inflammation, as there are a wide variety of possible causes, with some causes being the result of more serious conditions. They can identify the cause and will make sure you receive the treatment and care you need, depending on your specific diagnosis.