25th February 2025

Overview of infections and rheumatic disease

A number of microorganisms are linked to inflammatory rheumatic diseases. Pathogenesis can be through direct local infection and indirectly (‘reactive’) through pathogen-specific immune response and autoimmunity.

Viral

Often there is arthralgia or polyarthritis with viral infections, due to direct toxicity or immune complex deposition. Erythrovirus B19 (parvovirus, causes slapped cheek syndrome, usually in children), rubella and hepatitis B commonly give an acute symmetrical polyarthritis of the small joints of the hands, which resolves in a few weeks.

Bacterial

Common conditions with direct joint damage include septic arthritis, gonococcal arthritis and tuberculosis. The most common conditions with indirect damage are Lyme disease and rheumatic fever.

Other bacteria with rare rheumatological symptoms include meningococcus, brucellosis, syphilis, leprosy and in infective endocarditis.