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 |