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Table 1 Summary of clinical characteristics of Inflammatory Articular Syndromes in HIV positive patients

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