Version May 2024
| Comment | |
| Viruses | Viral arthritis usually involves multiple small joints |
| Varicella-zoster virus (VZV) | VZV may cause primary arthritis within several days of the onset of rash; monoarticular knee involvement is most common; varicella also may cause secondary bacterial arthritis by providing a portal of entry for Staphylococci or Streptococci |
| Hepatitis B virus (HBV) | 10 to 25% of patients with HBV develop arthritis, usually during the prodromal stage; joints of hands and knees most often affected; may be associated with urticarial and maculopapular eruption |
| Hepatitis C virus (HCV) | 2 to 20% of patients with HCV develop arthritis (evanescent or oligoarthritis) |
| Parvovirus | Arthralgia or arthritis may accompany or follow the skin eruption; the knee is most commonly affected joint |
| Enteroviruses | Rarely, coxsackie and echoviruses have been identified in synovial fluid in cases of inflammatory arthritis |
| Rubella | Joint symptoms develop within 1 week before or after the rash |
| Rubella vaccine virus | Joint symptoms develop approximately 2 weeks after vaccination |
| Mumps virus | Joint symptoms usually develop after the onset of parotitis |
| Chikungunya virus | Transmitted by mosquitos; may produce severe or prolonged arthralgia |
| Fungi | |
| Candida | May occur in neonates or immunocompromised children |
| Histoplasma | Endemic to the eastern and central United States and Canada; exposure to bird droppings, bat guano |
| Coccidioides | Endemic to the western United States, northern Mexico, parts of Central and South America |
| Sporothrix schenckii | Present in soil, moss, and other organic material; may be inoculated into the skin or inhaled |
| Blastomyces dermatitidis | Endemic in the southeastern and central states and Midwestern states bordering the Great Lakes of the United States |
| Postinfectious arthritis or reactive arthritis | Preceding episode of respiratory (group A Streptococcus, Neisseria meningitidis), gastrointestinal (eg, Shigella, Salmonella, Campylobacter), or genitourinary infection (Chlamydia trachomatis); may be associated with conjunctivitis, uveitis, or rash; onset of joint inflammation ≥7 days after acute infection; resolves without sequelae in 97 to 99% of cases; if obtained, synovial fluid WBC count usually is <50,000 cells/microL |
| Rheumatic fever | Evanescent and migratory arthritis; extreme pain and limited range of motion, but minimal effusion or swelling |
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