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Table 1 Summary of clinical characteristics of Inflammatory Articular Syndromes in HIV positive patients

From: Inflammatory arthritis in HIV positive patients: A practical guide

 

Clinical characteristics

  

Syndrome

HIV negative

HIV Positive

References

RA

Symmetrical small joint polyarthritis, hands and feet.

RA activity can improve with HIV and flare or arise de novo following HAART

-Reveille JD, Williams M. Rheumatologic complications of HIV infection. Best Practice & Research Clinical RheumatologyVol. 20, No. 6 -du Toit et alLack of specificity of anticyclic citrullinated peptide antibodies in advanced human immunodeficiency virus infection. J Rheumatol 2011;38:1055–60

Positive Rheumatoid Factor and/or Anti-CCP

HIV infection itself can be associated with false positive Rheumatoid Factor and CCP

Extra articular manifestations such as interstitial lung disease and rheumatoid nodules

HIV Arthropathy can mimic rheumatoid clinically

ESR may remain persistently raised despite good disease control

Reactive Arthritis

Seronegative peripheral oligo arthritis predominantly involving the lower extremities, usually accompanied by enthesitis. Keratoderma blenorrhagicum and circinate balanitis.

Skin involvement can be more florid than HIV –ve.

-Lawson E, Walker-Bone K. The changing spectrum of rheumatic disease in HIV infection Br Med Bull. 2012 Sep;103(1):203-21

Psoriaform rashes can be so extensive as to cause diagnostic confusion with PsA.

Axial involvement and uveitis are less common than HIV –ve

HLA B27 commoner in Caucasians than black Africans

Psoriatic Arthritis

Varied presentation:

Typical clinical phenotype is an asymmetrical oligo- or polyarthritis, with a predilection for the lower limbs

Njobvu P, McGill P. Psoriatic arthritis and human immunodeficiency virus infection in Zambia. J Rheumatol 2000;27:1699–702

Inflammatory joint pain/spinal pain

Distal interphalangeal joint swelling, dactilytis, symmetrical polyarthritis, spondylitis, enthesitis and arthritis mutilans

Can present with an abrupt-onset florid polyarthritis, particularly in advanced HIV

History of Psoriasis or family history

More severe and persistent skin lesions with guttate, inverse and erythrodermic subtypes compared to HIV -ve

Distal interphalangeal involvement and axial SPA patterns appear less frequently compared to HIV -ve

Undifferentiated Spondyloarthropathy

Clinical manifestations of ankylosing spondylitis, reactive arthritis, or PsA without full spectrum to be classified as any syndrome

Achilles tendinitis, dactylitis, low-back pain, plantar fasciitis, ankle pain and shoulder pain most commonly.

Mody G, Parke F. Articular manifestations of human immunodeficiency virus infection. Best Practice & Research Clinical RheumatologyVol. 17, No. 2, pp. 265–287, 2003

Painful articular syndrome

N/A

Severe bone and joint pain in the lower extremities in an asymmetric pattern.

Reveille JD. The changing spectrum of rheumatic disease in human immunodeficiency virus infection. Semin Arthritis Rheum. 2000;30(3):147

No objective synovitis.

Can be debilitating

HIV Arthropathy

N/A

Presents as an asymmetric oligo arthritis, symmetrical polyarthritis or as a monoarthritis.

Plate A-M, Boyle B. Musculoskeletal Manifestations of HIV. AIDS Read. 2003;13(2)

Patients lack features of mucocutaneous involvement or enthesopathy

Symmetrical polyarthritis variant closely mimics RA.

Occasional erosions and joint space narrowing radiographically

ANA, Rheumatoid Factor and HLA B27 are negative

Sterile, inflammatory synovial fluid