HIV-Related Rheumatic Disease Syndrome
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Acquired immune deficiency syndrome, AIDS, is an infectious disease that has reached epidemic proportions both in this country and world-wide. The current estimate is that approximately 22 million people worldwide are infected with HIV; about 1 million of these are children. In the United States, it is estimated that, as of January 1993, between 630,000 and 897,000 adults and adolescents are living with HIV infection, including between 107,00 and 150,00 women.
Caused by a virus called human immunodeficiency virus (HIV) which is transmitted primarily through sexual contact, through blood and blood products, and from infected mothers to their infants either in utero or through breast milk, AIDS produces a spectrum of symptoms, including several arthritic-related conditions.
While HIV resembles a variety of autoimmune diseases, there is no evidence that HIV-infected individuals have an increase in two of the more common auto-immune 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.
Approximately 33% of HIV-infected individuals experience joint pain sometime during the course of the disease. Between 5 and 10 percent are diagnosed as having some form of reactive arthritis, such as Reiter's syndrome or psoriatic arthritis. As the virus progresses and the immune system declines, arthritic symptoms are more likely to take hold.
If you are infected with HIV, you may also experience a variety of joint problems that seem to have no apparent cause. This syndrome is called HIV- or AIDS-associated arthropathy. Characterized by discomfort and stiffness that develop over a period of one to six weeks and lasting six weeks to six months, it generally involves the large joints - hips, knees, ankles. Usually the condition does not cause long-term damage and only mild inflammation. Anti-inflammatory drugs are only mildly effective; injections of steroids seem to provide greater relief.
Another form of arthritis that seems to be related to HIV is called painful articular syndrome. Present in about 10% of AIDS patients, this form is characterized by acute, severe, sharp pain in knees, elbows, and shoulders. Although research is inconclusive, it is generally thought that this form of arthritis occurs when HIV directly affects the joint.
Joint pain, achiness, swelling, and stiffness If you have already tested positive for HIV, your doctor will likely consider any joint and muscle pain and stiffness you report as reactive to the virus. He will therefore make any treatment and preventative recommendations within the overall context of your condition.
Generally, HIV-related arthritic
symptoms respond well to standard treatment: NSAIDs - aspirin, ibuprofen (Advil,
Nuprin, Motrin) to reduce pain and swelling; moderate exercises; a healthy,
balanced diet. The pain of painful
articular syndrome usually lasts anywhere from 2 to 24 hours and may be
severe enough to require narcotic analgesics - codeine, for example. When the
arthritic symptoms are more severe or persistent, your doctor may recommend
short courses of corticosteriods or immunosuppressant agents, although the use
of these, especially methotrexate, 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.
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