Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Specific viruses that cause arthritis

INTRODUCTION

Arthralgia and/or arthritis are well-recognized and relatively common occurrences with viral infections. This topic will review the more common viral infections that can cause arthritic symptoms. An overview of pathogenesis and diagnosis of viral arthritis is presented separately. (See "Pathogenesis and diagnosis of viral arthritis".)

HEPATITIS A VIRUS

In hepatitis A virus (HAV) infections, arthralgias and rash occur in 10 to 14 percent of patients, but arthritis is extremely rare and there is some suspicion that patients with arthritis attributed to HAV infection truly had hepatitis C (HCV). Arthritis has been described primarily in patients with vasculitis who had a chronic relapsing form of hepatitis A, and also high titer of polyclonal IgG- and IgM-circulating cryoglobulins (type III cryoglobulinemia) [1].

HEPATITIS B VIRUS

Individuals infected with the hepatitis B virus (HBV) can be either asymptomatic or symptomatic. Asymptomatic infection is more common than the latter, especially in young children. Most primary infections in adults are self-limited, with clearance of the virus from the blood and liver and the development of lasting immunity to reinfection [2,3]. However, some primary infections in healthy adults, generally less than 5 percent, do not resolve, but develop into persistent infections. This is manifested by serological evidence of a primary infection by the appearance of hepatitis B surface antigen (HBsAg), followed shortly by IgM antibodies against HBV core antigen (anti-HBc antibodies); then circulating HBeAg becomes detectable.

Clinically, a prodromal phase of one to six months is followed by the onset of nonspecific symptoms including fever, nausea, vomiting, anorexia, and abdominal pain, which generally precedes the onset of icterus by 1 to 14 days [2,3]. In such cases, viral replication continues in the liver and there is continued viremia, although the titers of the virus in the liver and blood are variable.

People with subclinical persistent infection, normal serum aminotransferase levels, and nearly normal findings on liver biopsy are termed asymptomatic chronic HBV carriers; those with abnormal liver function and histologic features are classified as having chronic hepatitis B. During the prodromal phase and the early phase of clinical disease, HBsAg may be evident in the circulation. Only later does anti-HBsAg appear with a subsequent clearance of circulating viral products. Joint symptoms associated with HBV infections are believed to be due to the formation and deposition of immune complexes; cryoprecipitates containing HBsAg and complement components have been reported in affected patients [4,5]. Affected patients may have an earlier anti-HBsAg response, promoting immune complex formation [4].

                        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2014. | This topic last updated: Jul 26, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Inman RD, Hodge M, Johnston ME, et al. Arthritis, vasculitis, and cryoglobulinemia associated with relapsing hepatitis A virus infection. Ann Intern Med 1986; 105:700.
  2. Ganem D, Prince AM. Hepatitis B virus infection--natural history and clinical consequences. N Engl J Med 2004; 350:1118.
  3. Wright TL, Lau JY. Clinical aspects of hepatitis B virus infection. Lancet 1993; 342:1340.
  4. Wands JR, Mann E, Alpert E, Isselbacher KJ. The pathogenesis of arthritis associated with acute hepatitis-B surface antigen-positive hepatitis. Complement activation and characterization of circulating immune complexes. J Clin Invest 1975; 55:930.
  5. Shumaker JB, Goldfinger SE, Alpert E, Isselbacher KJ. Arthritis and rash. Clues to anicteric viral hepatitis. Arch Intern Med 1974; 133:483.
  6. Hsu HH, Feinstone SM, Houfnagle JH. Acute viral hepatitis. In: Mandell, Douglas, and Bennett's Principles and Practices of Infectious Diseases, Fourth Edition, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, New York 1995. p.1100.
  7. Alarcon GS, Townes AS. Arthritis in viral hepatitis. Report of two cases and review of the literature. Johns Hopkins Med J 1973; 132:1.
  8. Guillevin L, Lhote F, Cohen P, et al. Polyarteritis nodosa related to hepatitis B virus. A prospective study with long-term observation of 41 patients. Medicine (Baltimore) 1995; 74:238.
  9. Johnson RJ, Couser WG. Hepatitis B infection and renal disease: clinical, immunopathogenetic and therapeutic considerations. Kidney Int 1990; 37:663.
  10. Levo Y, Gorevic PD, Kassab HJ, et al. Association between hepatitis B virus and essential mixed cryoglobulinemia. N Engl J Med 1977; 296:1501.
  11. Cacoub P, Poynard T, Ghillani P, et al. Extrahepatic manifestations of chronic hepatitis C. MULTIVIRC Group. Multidepartment Virus C. Arthritis Rheum 1999; 42:2204.
  12. Rosner I, Rozenbaum M, Toubi E, et al. The case for hepatitis C arthritis. Semin Arthritis Rheum 2004; 33:375.
  13. Pawlotsky JM, Roudot-Thoraval F, Simmonds P, et al. Extrahepatic immunologic manifestations in chronic hepatitis C and hepatitis C virus serotypes. Ann Intern Med 1995; 122:169.
  14. Rivera J, García-Monforte A, Pineda A, Millán Núñez-Cortés J. Arthritis in patients with chronic hepatitis C virus infection. J Rheumatol 1999; 26:420.
  15. Nesher G, Osborn TG, Moore TL. Parvovirus infection mimicking systemic lupus erythematosus. Semin Arthritis Rheum 1995; 24:297.
  16. Moore TL, Bandlamudi R, Alam SM, Nesher G. Parvovirus infection mimicking systemic lupus erythematosus in a pediatric population. Semin Arthritis Rheum 1999; 28:314.
  17. Pavlovic M, Kats A, Cavallo M, Shoenfeld Y. Clinical and molecular evidence for association of SLE with parvovirus B19. Lupus 2010; 19:783.
  18. Naides SJ. Rheumatic manifestations of parvovirus B19 infection. Rheum Dis Clin North Am 1998; 24:375.
  19. Török TJ. Parvovirus B19 and human disease. Adv Intern Med 1992; 37:431.
  20. Moore TL. Parvovirus-associated arthritis. Curr Opin Rheumatol 2000; 12:289.
  21. Reed MR. Gilliam BE, Syed RH, Moore TL. Rheumatic manifestation of Parvovirus B19 in children. J Pediatr Infect Dis 2009; 4:321.
  22. Young NS, Brown KE. Parvovirus B19. N Engl J Med 2004; 350:586.
  23. Nikkari S, Luukkainen R, Möttönen T, et al. Does parvovirus B19 have a role in rheumatoid arthritis? Ann Rheum Dis 1994; 53:106.
  24. Speyer I, Breedveld FC, Dijkmans BA. Human parvovirus B19 infection is not followed by inflammatory joint disease during long term follow-up. A retrospective study of 54 patients. Clin Exp Rheumatol 1998; 16:576.
  25. Söderlund M, von Essen R, Haapasaari J, et al. Persistence of parvovirus B19 DNA in synovial membranes of young patients with and without chronic arthropathy. Lancet 1997; 349:1063.
  26. Takasawa N, Munakata Y, Ishii KK, et al. Human parvovirus B19 transgenic mice become susceptible to polyarthritis. J Immunol 2004; 173:4675.
  27. Gershon AA. Rubella virus. In: Principles and Practices of Infectious Diseases, Third Edition, Mandell GL, Douglas Jr RG, Bennett JE (Eds), Churchill Livingstone, New York 1990. p.1242.
  28. Chantler JK, Tingle AJ, Petty RE. Persistent rubella virus infection associated with chronic arthritis in children. N Engl J Med 1985; 313:1117.
  29. Fraser JR, Cunningham AL, Hayes K, et al. Rubella arthritis in adults. Isolation of virus, cytology and other aspects of the synovial reaction. Clin Exp Rheumatol 1983; 1:287.
  30. Ford DK, da Roza DM, Reid GD, et al. Synovial mononuclear cell responses to rubella antigen in rheumatoid arthritis and unexplained persistent knee arthritis. J Rheumatol 1982; 9:420.
  31. Chantler JK, da Roza DM, Bonnie ME, et al. Sequential studies on synovial lymphocyte stimulation by rubella antigen, and rubella virus isolation in an adult with persistent arthritis. Ann Rheum Dis 1985; 44:564.
  32. Tingle AJ, Chantler JK, Pot KH, et al. Postpartum rubella immunization: association with development of prolonged arthritis, neurological sequelae, and chronic rubella viremia. J Infect Dis 1985; 152:606.
  33. Chantler JK, Ford DK, Tingle AJ. Rubella-associated arthritis: rescue of rubella virus from peripheral blood lymphocytes two years postvaccination. Infect Immun 1981; 32:1274.
  34. Smith CA, Petty RE, Tingle AJ. Rubella virus and arthritis. Rheum Dis Clin North Am 1987; 13:265.
  35. Ogra PL, Herd JK. Arthritis associated with induced rubella infection. J Immunol 1971; 107:810.
  36. Mitchell LA, Tingle AJ, Grace M, et al. Rubella virus vaccine associated arthropathy in postpartum immunized women: influence of preimmunization serologic status on development of joint manifestations. J Rheumatol 2000; 27:418.
  37. Ray P, Black S, Shinefield H, et al. Risk of chronic arthropathy among women after rubella vaccination. Vaccine Safety Datalink Team. JAMA 1997; 278:551.
  38. Slater PE. Chronic arthropathy after rubella vaccination in women. False alarm? JAMA 1997; 278:594.
  39. Spruance SL, Metcalf R, Smith CB, et al. Chronic arthropathy associated with rubella vaccination. Arthritis Rheum 1977; 20:741.
  40. Grahame R, Armstrong R, Simmons N, et al. Chronic arthritis associated with the presence of intrasynovial rubella virus. Ann Rheum Dis 1983; 42:2.
  41. Suhrbier A, La Linn M. Clinical and pathologic aspects of arthritis due to Ross River virus and other alphaviruses. Curr Opin Rheumatol 2004; 16:374.
  42. Toivanen A. Alphaviruses: an emerging cause of arthritis? Curr Opin Rheumatol 2008; 20:486.
  43. Hoarau JJ, Jaffar Bandjee MC, Krejbich Trotot P, et al. Persistent chronic inflammation and infection by Chikungunya arthritogenic alphavirus in spite of a robust host immune response. J Immunol 2010; 184:5914.
  44. Centers for Disease Control and Prevention. Chikungunya in the Caribbean. http://wwwnc.cdc.gov/travel/notices/watch/chikungunya-saint-martin (Accessed on June 02, 2014).
  45. Morens DM, Fauci AS. Chikungunya at the door--déjà vu all over again? N Engl J Med 2014; 371:885.
  46. Pan American Health Organization, World Health Organization. Chikungunya. http://www.paho.org/hq/index.php?option=com_content&view=article&id=9053&Itemid=39843 (Accessed on July 21, 2014).
  47. Fischer M, Staples JE, Arboviral Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, CDC. Notes from the field: chikungunya virus spreads in the Americas - Caribbean and South America, 2013-2014. MMWR Morb Mortal Wkly Rep 2014; 63:500.
  48. Centers for Disease Control and Prevention. CDC newsroom - press release. First Chikungunya case acquired in the United States reported in Florida. http://www.cdc.gov/media/releases/2014/p0717-chikungunya.html (Accessed on July 18, 2014).
  49. Florida Health. Florida Department of Health confirms first locally acquired cases of chikungunya fever. http://newsroom.doh.state.fl.us/wp-content/uploads/newsroom/2014/05/071714-Locally-Aquired-Chikungunya.pdf (Accessed on July 18, 2014).
  50. Centers for Disease Control and Prevention. Chikungunya virus in the United States. http://www.cdc.gov/chikungunya/geo/united-states.html (Accessed on July 18, 2014).
  51. Soden M, Vasudevan H, Roberts B, et al. Detection of viral ribonucleic acid and histologic analysis of inflamed synovium in Ross River virus infection. Arthritis Rheum 2000; 43:365.
  52. Way SJ, Lidbury BA, Banyer JL. Persistent Ross River virus infection of murine macrophages: an in vitro model for the study of viral relapse and immune modulation during long-term infection. Virology 2002; 301:281.
  53. Gerszten RE, Garcia-Zepeda EA, Lim YC, et al. MCP-1 and IL-8 trigger firm adhesion of monocytes to vascular endothelium under flow conditions. Nature 1999; 398:718.
  54. Mateo L, La Linn M, McColl SR, et al. An arthrogenic alphavirus induces monocyte chemoattractant protein-1 and interleukin-8. Intervirology 2000; 43:55.
  55. Linn ML, Mateo L, Gardner J, Suhrbier A. Alphavirus-specific cytotoxic T lymphocytes recognize a cross-reactive epitope from the capsid protein and can eliminate virus from persistently infected macrophages. J Virol 1998; 72:5146.
  56. ROBINSON MC. An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53. I. Clinical features. Trans R Soc Trop Med Hyg 1955; 49:28.
  57. Bodenmann P, Genton B. Chikungunya: an epidemic in real time. Lancet 2006; 368:258.
  58. Johnston REPC. Alphaviruses. In: Virology, Third Edition, Fields BN, Knipe DM, Howley PM, et al (Eds), Lippincott-Raven, Philadelphia 1996. p.843.
  59. Mylonas AD, Brown AM, Carthew TL, et al. Natural history of Ross River virus-induced epidemic polyarthritis. Med J Aust 2002; 177:356.
  60. Brighton SW, Prozesky OW, de la Harpe AL. Chikungunya virus infection. A retrospective study of 107 cases. S Afr Med J 1983; 63:313.
  61. Simon F, Parola P, Grandadam M, et al. Chikungunya infection: an emerging rheumatism among travelers returned from Indian Ocean islands. Report of 47 cases. Medicine (Baltimore) 2007; 86:123.
  62. Chopra A, Anuradha V, Lagoo-Joshi V, et al. Chikungunya virus aches and pains: an emerging challenge. Arthritis Rheum 2008; 58:2921.
  63. Harley D, Sleigh A, Ritchie S. Ross River virus transmission, infection, and disease: a cross-disciplinary review. Clin Microbiol Rev 2001; 14:909.
  64. Rigau-Pérez JG. The early use of break-bone fever (Quebranta huesos, 1771) and dengue (1801) in Spanish. Am J Trop Med Hyg 1998; 59:272.
  65. Kalayanarooj S, Vaughn DW, Nimmannitya S, et al. Early clinical and laboratory indicators of acute dengue illness. J Infect Dis 1997; 176:313.
  66. Schmidt AC. Response to dengue fever--the good, the bad, and the ugly? N Engl J Med 2010; 363:484.
  67. Naides SJ. Viral arthritis. In: Kelley's Textbook of Rheumatology, Seventh Edition, Harris ED, Budd RC, Genovese MC, et al (Eds), Elseveier-Saunder, Philadelphia 2005. p.1688.
  68. Gordon SC, Lauter CB. Mumps arthritis: a review of the literature. Rev Infect Dis 1984; 6:338.
  69. Zeichhardt H, Grunert HP. Enteroviruses. In: Infectious Disease Textbook, First Edition, Armstrong D, Cohen J (Eds), Mosby, London 1999. p.8212.
  70. Kujala G, Newman JH. Isolation of echovirus type 11 from synovial fluid in acute monocytic arthritis. Arthritis Rheum 1985; 28:98.
  71. Blotzer JW, Myers AR. Echovirus-associated polyarthritis. Report of a case with synovial fluid and synovial histologic characterization. Arthritis Rheum 1978; 21:978.
  72. Hurst NP, Martynoga AG, Nuki G, et al. Coxsackie B infection and arthritis. Br Med J (Clin Res Ed) 1983; 286:605.
  73. Ackerson BK, Raghunathan R, Keller MA, et al. Echovirus 11 arthritis in a patient with X-linked agammaglobulinemia. Pediatr Infect Dis J 1987; 6:485.
  74. Fraser KJ, Clarris BJ, Muirden KD, et al. A persistent adenovirus type 1 infection in synovial tissue from an immunodeficient patient with chronic, rheumatoid-like polyarthritis. Arthritis Rheum 1985; 28:455.
  75. Fierman AH. Varicella-associated arthritis occurring before the exanthem. Case report and literature review. Clin Pediatr (Phila) 1990; 29:188.
  76. Pascual-Gómez E. Identification of large mononuclear cells in varicella arthritis. Arthritis Rheum 1980; 23:519.
  77. Callan MF. Epstein-Barr virus, arthritis, and the development of lymphoma in arthritis patients. Curr Opin Rheumatol 2004; 16:399.
  78. Harley JB, James JA. Everyone comes from somewhere: systemic lupus erythematosus and Epstein-Barr virus induction of host interferon and humoral anti-Epstein-Barr nuclear antigen 1 immunity. Arthritis Rheum 2010; 62:1571.
  79. Quan TE, Roman RM, Rudenga BJ, et al. Epstein-Barr virus promotes interferon-alpha production by plasmacytoid dendritic cells. Arthritis Rheum 2010; 62:1693.
  80. Rickinson AB, Kieff E. Epstein-Barr virus. In: Virology, Third Edition, Fields BN, Knipe DM, Howley PM, et al (Eds), Lippincott-Raven, Philadelphia 1996. p.2397.
  81. Sigal LH, Steere AC, Niederman JC. Symmetric polyarthritis associated with heterophile-negative infectious mononucleosis. Arthritis Rheum 1983; 26:553.
  82. Gilliam BE, Reed MR, Syed RH, Moore TL. Rheumatic manifestations of Epstein-Barr virus in children. J Pediatr Infect Dis 2009; 4:333.
  83. Friedman HM, Pincus T, Gibilisco P, et al. Acute monoarticular arthritis caused by herpes simplex virus and cytomegalovirus. Am J Med 1980; 69:241.
  84. Remafedi G, Muldoon RL. Acute monarticular arthritis caused by herpes simplex virus type I. Pediatrics 1983; 72:882.
  85. Eisenstein EM, Wolf DG. Cytomegalovirus infection in pediatric rheumatic diseases: a review. Pediatr Rheumatol Online J 2010; 8:17.
  86. Fiala M, Payne JE, Berne TV, et al. Epidemiology of cytomegalovirus infection after transplantation and immunosuppression. J Infect Dis 1975; 132:421.
  87. Rubin RH. Clinical approach to infection in the compromised host. In: Infection in the organ transplant recipient, First Edition, Rubin RH, Young NS (Eds), Kluwer Academic Press, New York 2002. p.573.
  88. Michaels FH, Banks KL, Reitz MS Jr. Lessons from caprine and ovine retrovirus infections. Rheum Dis Clin North Am 1991; 17:5.
  89. UNAIDS/WHO. Global Report: 2009.
  90. Nguyen BY, Reveille JD. Rheumatic manifestations associated with HIV in the highly active antiretroviral therapy era. Curr Opin Rheumatol 2009; 21:404.
  91. Centers for Disease Control and Prevention (CDC). The Global HIV/AIDS pandemic, 2006. MMWR Morb Mortal Wkly Rep 2006; 55:841.
  92. Reveille JD. The changing spectrum of rheumatic disease in human immunodeficiency virus infection. Semin Arthritis Rheum 2000; 30:147.
  93. Maganti RM, Reveille JD, Williams FM. Therapy insight: the changing spectrum of rheumatic disease in HIV infection. Nat Clin Pract Rheumatol 2008; 4:428.
  94. Rynes RI, Goldenberg DL, DiGiacomo R, et al. Acquired immunodeficiency syndrome-associated arthritis. Am J Med 1988; 84:810.
  95. Berman A, Cahn P, Perez H, et al. Human immunodeficiency virus infection associated arthritis: clinical characteristics. J Rheumatol 1999; 26:1158.
  96. Winchester R, Bernstein DH, Fischer HD, et al. The co-occurrence of Reiter's syndrome and acquired immunodeficiency. Ann Intern Med 1987; 106:19.
  97. Cuellar ML, Espinoza LR. Rheumatic manifestations of HIV-AIDS. Baillieres Best Pract Res Clin Rheumatol 2000; 14:579.
  98. Clark MR, Solinger AM, Hochberg MC. Human immunodeficiency virus infection is not associated with Reiter's syndrome. Data from three large cohort studies. Rheum Dis Clin North Am 1992; 18:267.
  99. Brancato L, Itescu S, Skovron ML, et al. Aspects of the spectrum, prevalence and disease susceptibility determinants of Reiter's syndrome and related disorders associated with HIV infection. Rheumatol Int 1989; 9:137.
  100. Solomon G, Brancato L, Winchester R. An approach to the human immunodeficiency virus-positive patient with a spondyloarthropathic disease. Rheum Dis Clin North Am 1991; 17:43.
  101. Njobvu P, McGill P. Human immunodeficiency virus related reactive arthritis in Zambia. J Rheumatol 2005; 32:1299.
  102. Bourinbaiar AS, Lee-Huang S. The non-steroidal anti-inflammatory drug, indomethacin, as an inhibitor of HIV replication. FEBS Lett 1995; 360:85.
  103. Youssef PP, Bertouch JV, Jones PD. Successful treatment of human immunodeficiency virus-associated Reiter's syndrome with sulfasalazine. Arthritis Rheum 1992; 35:723.
  104. Disla E, Rhim HR, Reddy A, Taranta A. Improvement in CD4 lymphocyte count in HIV-Reiter's syndrome after treatment with sulfasalazine. J Rheumatol 1994; 21:662.
  105. Sperber K, Kalb TH, Stecher VJ, et al. Inhibition of human immunodeficiency virus type 1 replication by hydroxychloroquine in T cells and monocytes. AIDS Res Hum Retroviruses 1993; 9:91.
  106. Maurer TA, Zackheim HS, Tuffanelli L, Berger TG. The use of methotrexate for treatment of psoriasis in patients with HIV infection. J Am Acad Dermatol 1994; 31:372.
  107. Masson C, Chennebault JM, Leclech C. Is HIV infection contraindication to the use of methotrexate in psoriatic arthritis? J Rheumatol 1995; 22:2191.
  108. Gaylis N. Infliximab in the treatment of an HIV positive patient with Reiter's syndrome. J Rheumatol 2003; 30:407.
  109. Neumann S, Kreth F, Schubert S, et al. Reiter's syndrome as a manifestation of an immune reconstitution syndrome in an HIV-infected patient: successful treatment with doxycycline. Clin Infect Dis 2003; 36:1628.
  110. Zalavras CG, Dellamaggiora R, Patzakis MJ, et al. Septic arthritis in patients with human immunodeficiency virus. Clin Orthop Relat Res 2006; 451:46.
  111. Reveille JD, Conant MA, Duvic M. Human immunodeficiency virus-associated psoriasis, psoriatic arthritis, and Reiter's syndrome: a disease continuum? Arthritis Rheum 1990; 33:1574.
  112. Forman SB, Higginson R, Garrett AB. Psoriasis and psoriatic arthritis in a patient with HIV: response to mycophenolate mofetil treatment. J Drugs Dermatol 2008; 7:972.
  113. Cepeda EJ, Williams FM, Ishimori ML, et al. The use of anti-tumour necrosis factor therapy in HIV-positive individuals with rheumatic disease. Ann Rheum Dis 2008; 67:710.
  114. Itescu S, Brancato LJ, Buxbaum J, et al. A diffuse infiltrative CD8 lymphocytosis syndrome in human immunodeficiency virus (HIV) infection: a host immune response associated with HLA-DR5. Ann Intern Med 1990; 112:3.
  115. Basu D, Williams FM, Ahn CW, Reveille JD. Changing spectrum of the diffuse infiltrative lymphocytosis syndrome. Arthritis Rheum 2006; 55:466.
  116. Atkinson JC, Schiødt M, Robataille S, et al. Salivary autoantibodies in HIV-associated salivary gland disease. J Oral Pathol Med 1993; 22:203.
  117. Itescu S, Dalton J, Zhang HZ, Winchester R. Tissue infiltration in a CD8 lymphocytosis syndrome associated with human immunodeficiency virus-1 infection has the phenotypic appearance of an antigenically driven response. J Clin Invest 1993; 91:2216.
  118. Kaye BR. Rheumatologic manifestations of infection with human immunodeficiency virus (HIV). Ann Intern Med 1989; 111:158.
  119. Fabris P, Tositti G, Giordani MT, et al. Prevalence and clinical significance of circulating cryoglobulins in HIV-positive patients with and without co-infection with hepatitis C virus. J Med Virol 2003; 69:339.
  120. Klaassen RJ, Goldschmeding R, Dolman KM, et al. Anti-neutrophil cytoplasmic autoantibodies in patients with symptomatic HIV infection. Clin Exp Immunol 1992; 87:24.
  121. Hazarika I, Chakravarty BP, Dutta S, Mahanta N. Emergence of manifestations of HIV infection in a case of systemic lupus erythematosus following treatment with IV cyclophosphamide. Clin Rheumatol 2006; 25:98.
  122. Chetty R, Batitang S, Nair R. Large artery vasculopathy in HIV-positive patients: another vasculitic enigma. Hum Pathol 2000; 31:374.
  123. Herranz P, Fernández-Díaz ML, de Lucas R, et al. Cutaneous vasculitis associated with didanosine. Lancet 1994; 344:680.
  124. Torres RA, Lin RY, Lee M, Barr MR. Zidovudine-induced leukocytoclastic vasculitis. Arch Intern Med 1992; 152:850.
  125. French MA, Lewin SR, Dykstra C, et al. Graves' disease during immune reconstitution after highly active antiretroviral therapy for HIV infection: evidence of thymic dysfunction. AIDS Res Hum Retroviruses 2004; 20:157.
  126. Bonham S, Meya DB, Bohjanen PR, Boulware DR. Biomarkers of HIV Immune Reconstitution Inflammatory Syndrome. Biomark Med 2008; 2:349.
  127. Calabrese LH, Naides SJ. Viral arthritis. Infect Dis Clin North Am 2005; 19:963.
  128. Calabrese LH, Kirchner E, Shrestha R. Rheumatic complications of human immunodeficiency virus infection in the era of highly active antiretroviral therapy: emergence of a new syndrome of immune reconstitution and changing patterns of disease. Semin Arthritis Rheum 2005; 35:166.