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Viral Arthritis — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyViral ArthritisSCE Rheumatology

A 45-year-old man presents with 4 weeks of bilateral wrist and MCP joint swelling. He has also developed a maculopapular rash on his trunk and thighs. He works as a primary school teacher. Serology shows positive parvovirus B19 IgM. RF is transiently positive. What is the most appropriate management?

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Correct answer: D — Symptomatic treatment with NSAIDs and reassurance about likely self-resolution

Parvovirus B19 infection is a common mimic of early RA, presenting with symmetric small joint polyarthritis and can cause transient RF positivity. In immunocompetent adults, it is self-limiting within 2-6 weeks and management is supportive (NSAIDs, analgesics). Starting DMARDs is not appropriate for viral arthritis. Positive B19 IgM with compatible clinical features confirms the diagnosis. IgG seroconversion confirms previous infection. It is important to distinguish from true RA to avoid unnecessary immunosuppression.

Reference: NICE CKS - Parvovirus B19; Kennedy S et al 1985 B19 arthritis in adults