Arthritis, usually accompanied by fever and myositis, with or without a rash, is a common presentation of infections with many arboviruses of three families: the togaviruses, flaviviruses, and bunyaviruses (see Chapters 25, 26, and 33 and Table 36-8). The togaviruses chikungunya, o'nyong-nyong, and Ross River viruses, in particular, have caused huge epidemics of polyarthritis in Asia and Africa, Africa, and the Pacific islands, respectively. Arthritis is a somewhat less prominent feature of rubella but is common in adult females following either natural infection or rubella vaccine. Polyarthralgia is also an important feature of infection with the parvovirus B19, especially in women, and may smolder on for months, in all these diseases the polyarthritis lends to flit from one joint to another, involving principally the extremities such as the hands; only rarely does it persist for more than a few weeks. Much less frequently, ephemeral arthritis is seen in mumps, varicella, and coxsackievirus infection. The arthralgia sometimes observed in the prodromal stages of hepatitis B is immunologically mediated. Many people sense that rheumatoid arthritis may be of viral origin, but the quarry has proved to be elusive.
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