Articular symptoms and signs associated with HBV infection
As in all viral illnesses, arthralgia is much more common than arthritis in HBV infection (20% with arthralgia, <10% with arthritis). Arthritis can occur in both the prodromal phase of acute infection and during a chronic infection, but occurrence in the prodromal phase is the classic type. During this phase of acute infection, patients develop either a migratory or additive arthritis resulting in a symmetric polyarthritis involving the proximal interphalangeal (PIP), knees, and ankle joints mimicking RA. The arthritis typically precedes jaundice and transaminitis; it may last for days or months and resolves with the onset of jaundice. Accompanying symptoms include fever, malaise, myalgia, and rash (maculopapular, urticarial, petechial; the so-called arthritis–dermatitis syndrome).