Indian Journal of Physical Medicine & Rehabilitation (Apr 2009)
HIV Associated Arthritis
Abstract
Objectives: To find out pattern of joints involved andeffectiveness of a treatment program in HIV associatedarthritisMethods: A cohort of 26 Human ImmunodeficiencyVirus (HIV) associated arthritis patients (21 males and 5females) who attended Department of Physical Medicineand Rehabilitation of the Regional Institute of MedicalSciences, Imphal was studied during 2002 and 2005. CD4count and joint fluid examination including culture andsensitivity were performed before initiation of thetreatment. A management program consisting ofNSAIDs, intra-articular (I/A) methyl prednisoloneinjection upto a maximum of 3 times, range of mobilizationexercises, strengthening of muscles around the joint, localrestriction of activities to protect joints was instituted.Low dose oral corticosteroids was considered when therewas persistence of joint effusion after I/A methylprednisolone injection(s). Joint score, pain score andactivities of daily living score were assessed at baseline,3 and 6 months.Results: Mean age of the patients was 33.2 (SD, 6.6)years. Knee joint was involved in 22 cases followed byankle joint in 5 cases. More than two joints were involvedin 7 cases. Median CD4 count was 484 (range 231-897).The synovial fluid showed features of inflammation andwas sterile. Nineteen cases (73%) remained symptomfree for at least 3 months after I/A injection ofmethylprednisolone. Of the 7 refractory cases, all in kneejoints, two had associated hyperuricemia. Synovial biopsyshowed tuberculosis in one and the case responded tothe addition of antitubercular drugs. And other caseresponded to hypouricaemic drug. Four cases respondedto low dose oral corticosteroids and another caseresponded only after initiation of antiretroviral treatment.Conclusions: Knee was the most commonly involvedjoint. Intraarticular methylprednisolone seem to beeffective in the management of these cases in addition tothe rehabilitation program. Low dose oral prednisolne wasfound to be a good adjunct in refractory cases.
