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  • Title: Human immunodeficiency virus-related connective tissue diseases: a Zimbabwean perspective.
    Author: Davis P, Stein M.
    Journal: Rheum Dis Clin North Am; 1991 Feb; 17(1):89-97. PubMed ID: 2041891.
    Abstract:
    Our clinical experience with patients in Zimbabwe suggests that an arthropathy may be a feature of HIV disease. This takes two forms: the first is a reactive arthropathy usually affecting the large, lower limb joints with no other clinical features of a connective tissue disease. The second form is seen in association with features of complete or incomplete Reiter's syndrome with involvement of large and small peripheral joints (having an asymmetric distribution). Although this arthropathy may been seen in association with HIV positive asymptomatic disease and often is the reason for first presentation at hospital, the majority of our patients have clinical features of persistent generalized lymphadenopathy, plus or minus features of constitutional illness (such as fever, weight loss, and diarrhea). A small percentage of our patients have arthropathy in association with secondary systemic infection. Other locomotor conditions have been observed, although their numbers are too small to determine whether or not they truly are related to HIV disease. In Zimbabwe there is no association between the development of HIV-associated arthropathy and the presence of HLA-B27. A review of patients presenting at the rheumatology clinic of the Parirenyatwa Hospital, University of Zimbabwe School of Medicine, revealed 14 with HIV infections. Over a 6-month period, 141 patients had been diagnosed with rheumatic diseases, including 49 with rheumatoid arthritis, 18 with systemic lupus erythematosus (SLE), 5 with dermatomyositis and 3 with scleroderma. Rheumatic diseases were thought to be rare in this population, of whom only 0.2% carry the HLA B27 antigen. Recently a marked increase in patients with reactive or Reiter-like illness, the most common arthropathy in HIV+ patients, were referred. These 14 patients, mostly males, all had acute onset arthropathy, 5 with polyarthritis and 9 with oligoarticular diseases, usually of the knees and ankles, usually symmetrical, or asymmetrical in the small peripheral joints. Synovial fluid was negative except for leukocytosis. The duration of the illness was usually 3-6 months. In addition there were 3 HIV+ patients with complete Reiter's and 7 HIV+ with incomplete Reiter's syndrome, out of a total of 16 Reiter's patients. Among the associated symptoms were urethritis, cervicitis, conjunctivitis, balanitis and oral ulceration, but not psoriasis. These patients had elevated sedimentation rates, but otherwise negative blood findings, other than anemia. In contrast 36 patients with rheumatoid arthritis and 12 with SLE were HIV-. 2 HIV patients also had septic arthritis, a common condition in Zimbabwe.
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