Which physical findings are characteristic of rubella-caused viral arthritis?

Updated: Nov 12, 2019
  • Author: Rabea Ahmed Khouqeer, MD, FRCPC, FAAAAI; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Clinical features of arthritis associated with rubella virus infection (in both children and adults) include the following:

  • Low-grade fever, malaise, and coryza are typical

  • Rash (acute mild-to-severe viral exanthema [maculopapular rash]) appears first on the face, then the trunk and upper extremities, and finally on the lower extremities, sparing the palms and soles

  • Significant lymphadenopathy (posterior cervical, postauricular, and occipital) may be noted

  • Arthritis is usually sudden in onset, appearing 1 week before or after the rash; morning stiffness is symmetric and polyarticular in distribution (eg, fingers, knees, and wrists), brief in duration (lasting a few days to weeks), and without residua

  • Arthritis similar to that occurring with natural infection may also develop within a few weeks of vaccination by attenuated rubella virus; the HPV77/DK12 strain is the most arthritogenic of the vaccine strains available in the United States; the currently used RA27/3 strain causes postvaccination joint symptoms in about 15% of recipients

In children, the following 2 syndromes may occur with either natural infection or vaccination:

  • Arm syndrome – A brachial radiculoneuritis causes arm and hand pain and dysesthesias that worsen at night

  • Catcher’s crouch syndrome – A lumbar radiculoneuropathy causes popliteal fossa pain when the child arises in the morning

Both syndromes occur 1-2 months after vaccination. The first episode may last up to 2 months, but recurrence is usually shorter in duration. Catcher’s crouch syndrome may recur for up to a year but causes no permanent damage.


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