Vírus detected | ARI | Onset type | Signs of disease worsening or flare | Temporal relationship | Therapeutic decision |
---|---|---|---|---|---|
RSVA | NILI** | S | 10% increase in the number of active joints, 50% worsening of the patient’s subjective evaluation | Concomitant | Increase the dose of cyclosporine |
HAdv | ILI*** | S | 60% increase in the number of active joints and 200% worsening of the patient’s subjective evaluation | 3 weeks | Intra-articular infection |
HPIV1 | ILI | S | Flare# | Concomitant | None. Symptoms improved with resolution of Flu-like symptoms |
NC* | ILI | S | Flare | 5 days | Increase the dose of methotrexate and oral prednisone course |
HPIV3 | ILI | S | Flare with systemic symptoms | 7 days | Pulse of prednisone |
HAdv | ILI | O | Flare | 12 days | Restart methotrexate |
NC | NILI | P | 200% increase in number of active joints and 50% increase in ESR | 7 days | Start nonsteroidal antiinflammatory |
RSVA/HMPV | NILI | P | Flare | Concomitant | Increase prednisone dose |
Flu A | ILI | P | Worsening of morning stiffness and joint effusion. Appearance of cysts on wrists. | Concomitant | Start etanercept and leflunomide |
Confounding factor: varicella 8 days before | |||||
NC | ILI | S | Flare | 1 week Confounding factor: methotrexate suspended 30 days before | Pulse of prednisone |
Restart methotrexate |