What are the unique HIV associated arthritides? How does HIV associated arthritis differ from the painful articular syndrome?
HIV infection is associated with several distinct arthritis syndromes. Seroconversion can also be heralded by nonspecific arthralgia, myalgia, and polyarthritis.
HIV-associated arthritis is typically seronegative and oligoarticular involving lower extremity joints (knees and ankles). The synovial fluid is noninflammatory with negative cultures and normal radiographs. The symptoms tend to be self-limited, lasting 1 to 6 weeks, and respond to rest, physical therapy, nonsteroidal antiinflammatory drugs (NSAIDs), and low-dose corticosteroids. Once the clinical disorder resolves, the medications can be successfully discontinued. Rarely, a more prolonged arthritis can occur that results in joint-space narrowing and erosions, mimicking RA. Jaccoud arthropathy, a nonerosive metacarpophalangeal joint arthritis with ulnar deviation, has also been described. These patients may respond to NSAIDs, hydroxychloroquine, and/or sulfasalazine.
The painful articular syndrome is acute in onset, involves the knees, shoulders, and elbows, and lasts <24 hours. It occurs in late stages of HIV infection. It is speculated that this may represent transient bone ischemia since there is no evidence of synovitis. Narcotics are often necessary to relieve symptoms.