How does erythema infectiosum (fifth disease) manifest in the joints?

Updated: Mar 06, 2020
  • Author: Glenn L Zellman, MD; Chief Editor: Dirk M Elston, MD  more...
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When adults are exposed to PV-B19, an acute polyarthropathy is more likely to result than it is in classic erythema infectiosum. Polyarthropathy may start with a typical prodromal illness and some cutaneous aspect of erythema infectiosum but more often manifests simply by a new onset of symmetrical joint pain. Arthropathy is more common in women and can last for days to months.

The following, in decreasing order of frequency, are the most commonly affected sites:

  • Metacarpophalangeal and/or interphalangeal areas

  • Knees

  • Wrists

  • Ankles

Unlike rheumatoid arthritis, joint pain worsens over the day, and no joint destruction occurs. The synovial fluid is acellular and devoid of viral particles. An association with DR4 histocompatability alleles is recognized.

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