Suhrbier Andreas, La Linn May
Queensland Institute of Medical Research, Australian Centre for International & Tropical Health & Nutrition, Brisbane, Australia.
Curr Opin Rheumatol. 2004 Jul;16(4):374-9. doi: 10.1097/01.bor.0000130537.76808.26.
Arthritogenic alphaviruses are globally distributed mosquito-borne RNA viruses causing epidemics of polyarthritis/arthralgia, with disease emerging or reemerging and increasingly being reported in travelers. This article summarizes the current knowledge of these diseases, focusing on recent developments in the understanding of Ross River virus disease.
Alphaviral arthritides have often been blamed for protracted chronic illnesses. However, validated quality-of-life questionnaires and exhaustive searches for differential diagnoses showed that Ross River virus disease, although severe at onset, progressively resolved over 3 to 6 months. Many patients did experience long-term disease lasting more than 12 months, but in nearly all cases this was due to other conditions, primarily unrelated rheumatic conditions or depression. There is no indication that alphaviral arthritides predispose to other conditions; thus, patients whose Ross River virus disease has actually resolved may be underdiagnosed for other conditions. Ross River virus polyarthritis probably arises from inflammation associated with productive viral infections in synovial macrophages, which persist despite neutralizing antibodies and antiviral cytokine responses. Persistence may be facilitated by downregulation of cytokine responses by virus-antibody complexes binding to Fc receptors and induction of interleukin-10. How virus escapes neutralizing antibodies remains unclear but may involve phagocytosis of apoptotic virus-infected cells and infection of the phagocyte via the phagosome.
Diagnosis of alphaviral arthritides is complicated by nonspecific symptoms and the lack of commercial serodiagnostic kits, except for Ross River and Barmah Forest virus infections in Australia. Differential diagnoses should be actively pursued, especially if symptoms persist. Treatment with nonsteroidal anti-inflammatory drugs appears largely effective, with no evidence of long-term sequelae or relapse.
致关节炎甲病毒是全球分布的蚊媒RNA病毒，可引起多关节炎/关节痛流行，疾病不断出现或再次出现，且在旅行者中报告越来越多。本文总结了这些疾病的现有知识，重点关注罗斯河病毒病认识方面的最新进展。
甲病毒关节炎常被归咎于迁延不愈的慢性病。然而，经过验证的生活质量问卷以及对鉴别诊断的详尽搜索表明，罗斯河病毒病虽然起病时严重，但在3至6个月内逐渐缓解。许多患者确实经历了持续超过12个月的长期疾病，但几乎在所有情况下，这都是由于其他疾病，主要是无关的风湿性疾病或抑郁症。没有迹象表明甲病毒关节炎易引发其他疾病；因此，罗斯河病毒病实际已缓解的患者可能因其他疾病而被漏诊。罗斯河病毒多关节炎可能源于滑膜巨噬细胞中与病毒有效感染相关的炎症，尽管存在中和抗体和抗病毒细胞因子反应，这种炎症仍会持续。病毒-抗体复合物与Fc受体结合导致细胞因子反应下调以及白细胞介素-10的诱导可能有助于这种持续状态。病毒如何逃避中和抗体尚不清楚，但可能涉及凋亡的病毒感染细胞的吞噬作用以及通过吞噬体对吞噬细胞的感染。
除了澳大利亚的罗斯河病毒和巴马森林病毒感染外，非特异性症状和缺乏商业血清学诊断试剂盒使甲病毒关节炎的诊断变得复杂。应积极进行鉴别诊断，尤其是症状持续时。使用非甾体抗炎药治疗似乎基本有效，没有长期后遗症或复发的证据。
