HIV-Related Rheumatic Disease Syndrome
What Is It?
Many patients with HIV or AIDS develop pain and swelling of the joints at some point during the course of their disease, for a variety of reasons. Injection drug users may develop infected joints (septic arthritis). Those who are infected with hepatitis B or C may also develop joint pain. People at risk of sexually transmitted diseases can get a form of arthritis from gonorrhea. They can also get Reiter's syndrome -- either following a sexual transmitted disease or following a case of bacterial diarrhea -- which causes inflammation of the joints, eyes and genital tract (urethritis). Reiter's syndrome does not clearly occur more frequently in people with HIV infection, but the clinical course may be more prolonged and severe. Psoriasis, an inflammatory skin condition, also occurs in 5 percent of AIDS patients and is frequently associated with arthritis (psoriatic arthritis).
Other rheumatic problems in patients with HIV infection include muscle atrophy or inflammation, painful joints without arthritis, and fever with muscle and joint pain during anti-HIV therapy (perhaps related to improving immune function).
Although HIV resembles a variety of autoimmune diseases, there is no evidence that HIV-infected individuals have an increase in two of the more common autoimmune diseases, systemic lupus erythematous and rheumatoid arthritis. In fact, it has been observed that in some cases, these two conditions may be alleviated by the presence of HIV infection.
- Joint pain
If you develop joint pain and stiffness, your physician will ask you about the timing and duration of the pain, factors that make the pain better or worse, the severity of the pain, and possible risk factors for other medical problems that could be causing the joint pain. You will probably be asked about injection drug use and risk factors for sexually transmitted diseases. After a complete physical examination, blood tests may be warranted. If a joint is swollen, your doctor may suggest a joint tap (also called a joint aspiration or arthrocentesis), a procedure in which your doctor injects numbing medication into the skin over a joint and then inserts a small needle into the space around the affected joint. Removing fluid from the joint and analyzing it may be very helpful in determining the cause of your arthritis.
Treating arthritis in patients with HIV infection can be difficult. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), are only moderately effective in reducing pain and swelling. When the arthritic symptoms are more severe or persistent, your doctor may recommend short courses of corticosteroids or immunosuppressant agents, although the use of these can lead to infection with an already compromised immune system. As a result, they should be used with caution and only in the most severe cases.