Management for viral arthritis

The management of children with viral arthritis is beyond the scope of these guidelines—seek specialist advice.

There are no antiviral drugs available for the treatment of viral arthritis and, as most cases of viral arthritis are self-limiting, no specific treatment is required. Reassure patients about the favourable prognosis of the condition.

For relief of musculoskeletal symptoms, nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended first line. All of the NSAIDs listed below are equally effective and drug choice should be based on patient factors (eg comorbidities); see Choosing an NSAID for advice on drug choice. For relief of musculoskeletal symptoms associated with viral arthritis in adults, use:

1celecoxib 100 to 200 mg orally, daily in 1 or 2 divided doses, until symptoms subside celecoxib celecoxib celecoxib

OR

1etoricoxib 30 to 60 mg orally, daily until symptoms subside etoricoxib etoricoxib etoricoxib

OR

1ibuprofen immediate-release 200 to 400 mg orally, 3 or 4 times daily until symptoms subside ibuprofen ibuprofen ibuprofen

OR

1indometacin 25 to 50 mg orally, 2 to 4 times daily until symptoms subside indometacin indometacin indometacin

OR

1ketoprofen modified-release 200 mg orally, daily until symptoms subside ketoprofen ketoprofen ketoprofen

OR

1meloxicam 7.5 to 15 mg orally, daily until symptoms subside meloxicam meloxicam meloxicam

OR

1naproxen immediate-release 250 to 500 mg orally, twice daily until symptoms subside naproxen naproxen naproxen

OR

1naproxen modified-release 750 to 1000 mg orally, daily until symptoms subside naproxen naproxen naproxen

OR

1piroxicam 10 to 20 mg orally, daily until symptoms subside piroxicam piroxicam piroxicam

OR

2diclofenac 25 to 50 mg orally, 2 or 3 times daily until symptoms subside. diclofenac diclofenac diclofenac

Paracetamol may be used for symptom relief in combination with an NSAID, or instead of an NSAID if an NSAID is contraindicated or not tolerated. For relief of musculoskeletal symptoms associated with viral arthritis in adults, use:

1paracetamol immediate-release 1 g orally, 4- to 6-hourly, up to a maximum of 4 g daily paracetamol paracetamol paracetamol

OR

1paracetamol modified-release 1.33 g orally, 8-hourly. paracetamol paracetamol paracetamol

Corticosteroids are not recommended for the treatment of viral arthritis unless symptoms are disabling and the patient has a contraindication or intolerance to NSAIDs. If indicated, use a short course of low-dose therapy. An example dosage is:

prednisolone (or prednisone) 10 mg orally, daily for up to 2 weeks. prednis ol one prednis(ol)one prednis(ol)one

Treatment with disease-modifying antirheumatic drugs (DMARDs) is discouraged because symptoms have usually resolved by the onset of effect.

If symptoms are not improving by 6 weeks or significant symptoms persist beyond 12 weeks, even if improvement is seen, re-evaluate the patient for a possible diagnosis of rheumatoid arthritis and refer them to a specialist.