RHEUMATIC SYNDROMES ASSOCIATED WITH HIV-INFECTION - DIAGNOSIS, PATHOGENESIS AND MANAGEMENT

The association of HIV infection with rheumatic syndromes is reviewed, with emphasis on the specific differences between the rheumatic disea ses in their idiopathic form compared with their occurrence with HIV i nfection. Alterations in presentation, pathogenesis and treatment are stressed. The first section of the article concentrates on joint and a rticular involvement, and the second an autoimmune phenomenon in relat ion to lymphatic organs, muscle and vasculature. Wherever possible, th e direct effect of the HIV organism or its effect on the immune system modifying or contributing to the aetiology of each disease is discuss ed. HIV infection has many manifestations, and involvement of the musc uloskeletal system is not uncommon. Various infections of bone, joint and muscle have been described, which is not surprising considering th e immunodeficiency associated with HIV. Reiter's syndrome and the sero negative arthropathies and reactive arthritides also may be expected, particularly with the possible occurrence with sexually transmitted or ganisms. New onset of psoriasis in an adult should prompt the physicia n to consider HIV infection in the differential diagnosis. Perhaps mor e surprising is the occurrence of autoimmune diseases in association w ith HIV. However, as will be described, some of the associations such as rheumatoid arthritis and HIV are controversial and we attempt to de scribe current theories on pathogenesis, recognising that much more in vestigation is needed before we have a complete understanding of this disease.