Objective: To document the clinical and immunogenetic features of arthritis associated with heterosexually acquired human immunodeficiency virus (HIV) infection.
Methods: All patients were assessed by a rheumatologist and standard laboratory tests were performed.
Results: There were 3 common clinical presentations. (1) Oligo/polyarticular arthritis (22 men, 4 women). HIV infection had not previously been diagnosed in 24 of these patients but persistent generalized lymphadenopathy (85%) and weight loss (42%) were present. Joints commonly involved were ankles (65%) and knees (54%), often with associated enthesitis (31%) and dactylitis (23%). Followup data in 18 patients showed that arthritis resolved completely in 9 patients (one subsequently recurred), improved by >50% in 5 patients, was unremitting in 3 patients, and recurred frequently in one patient. None of 7 patients tested were HLA-B27 or B7 positive. (2) Reiter's syndrome (RS) (21 men, 3 women; incomplete RS 18 patients,complete RS 6 patients). Lymphadenopathy was present in 19 patients (79%) and 4 patients were previously known to have HIV infection. Involvement of knees (80%) and ankles (58%) was common, as were enthesitis (29%) and dactylitis (13%). Followup data in 21 patients showed that 14 resolved (5 with recurrences), 2 improved by >50%, and 5 had continued arthritis. HLA-B27 was not found in 13 patients tested but a cross reacting antigen was found in 6 patients. (3) Symmetrical polyarthritis (4 men, 4 women). Symmetrical arthritis of the wrists (8 patients) and peripheral interphalangeal (PIP) and metacarpophalangeal (MCP) joints (7), as well as lymphadenopathy (5), nodules (4), rheumatoid factor (3), and erosive radiographic changes (one patient) were seen. (4) Miscellaneous. Other types of arthritis included 3 patients with psoriasis and arthritis and one patient each with Behcet's disease, Salmonella septic arthritis, and secondary syphilis.
Conclusion: Arthritis associated with HIV in this population is most commonly characterized by oligoarticular, asymmetrical, large joint arthritis, with or without features of Reiter's syndrome, and is not associated with HLA-B27.
PIP: Patients with arthritis referred to the rheumatic disease clinic at the University of Zimbabwe or seen in consultation over a period of 4 years were studied. All 64 patients were assessed by a rheumatologist and standard laboratory tests were performed. There were three common clinical presentations. 1) Oligo- and polyarticular arthritis (22 men, 4 women). HIV infection had not previously been diagnosed in 24 of these patients, but persistent generalized lymphadenopathy (85%) and weight loss (42%) were present. Joints commonly involved were ankles (65%) and knees (54%), often with associated enthesitis (31%) and dactylitis (23%). Follow-up data in 18 patients showed that arthritis resolved completely in 9 patients (one subsequently recurred), improved by 50% in 5 patients, was unremitting in 3 patients, and recurred frequently in 1 patient. None of 7 patients tested possessed HLA-B27 or one of the B7 cross-reacting group (B7-CREG) of antigens. 2) Reiter's syndrome (RS) (21 men, 3 women: incomplete RS, 18 patients; complete RS, 6 patients). Lymphadenopathy was present in 19 patients (79%), and 4 patients were previously known to have HIV infection. Involvement of knees (80%) and ankles (58%) was common, as were enthesitis (29%) and dactylitis (13%). Follow-up data in 21 patients showed that 14 resolved (5 with recurrences), 2 improved by 50%, and 5 had continued arthritis. HL-B27 was not found 13 patients tested, but a cross-reacting antigen was found in 6 patients. 3) Symmetrical polyarthritis (4 men, 4 women). Symmetrical arthritis of the wrists (8 patients) and peripheral interphalangeal (PIP) and metacarpophalangeal (MCP) joints (7), as well as lymphadenopathy (5), nodules (4), rheumatoid factor (3), and erosive radiographic changes (1) were seen. Other types of arthritis included 3 patients with psoriasis and arthritis and 1 patient each with Beheet's disease, Salmonella septic arthritis, and secondary syphilis. All patients were treated with a nonsteroidal anti-inflammatory drug (NSAID), most commonly indomethacin, with the addition of low-dose prednisolone (5-10 mg for 4 patients) and/or chloroquine (150 mg base daily for 11 patients) if clinically indicated. In patients in whom arthritis improved, the effect was gradual over 3-6 months.