Rheumatologic Manifestations of HIV Infection
Infection with HIV has been associated with various rheumatic disorders, most commonly arthralgias and arthritis. HIV painful articular syndrome causes severe arthralgias in an oligoarticular, asymmetric pattern that resolves within 24 hours; the joint examination is normal. HIV-associated arthritis is an asymmetric oligoarticular process with objective findings of arthritis and a self-limited course that ranges from weeks to months. Psoriatic arthritis and reactive arthritis occur in HIV-infected individuals and can be severe; it remains uncertain whether the incidence of these disorders is increased in HIV-infected populations. These spondyloarthropathies can respond to NSAIDs, though many cases are unresponsive. In the era of highly active antiretroviral therapies, immunosuppressive medications can be used if necessary in HIV patients, though with caution. Muscle weakness associated with an elevated creatine kinase can be due to nucleoside reverse transcriptase inhibitor-associated myopathy or HIV-associated myopathy; the clinical presentations of each resemble idiopathic polymyositis but the muscle biopsies show minimal inflammation. Less commonly, an inflammatory myositis indistinguishable from idiopathic polymyositis occurs.