A 16-year-old girl comes to the office due to joint pain lasting several days. The patient says, "My hands and knees feel stiff when I wake up, and those joints are painful throughout the day." The symptoms are improving, but she still has significant discomfort with daily activities. The patient has never before had such symptoms. A mildly pruritic rash on her face, arms, and legs developed around the same time as the joint symptoms. Last week, the patient had an upper respiratory infection with fever and myalgias that resolved quickly without intervention. She has seasonal allergies for which she uses a glucocorticoid intranasal spray as needed. She does not use tobacco, alcohol, or illicit drugs. The patient is not in a relationship and has never been sexually active. Temperature is 37.2 C (99 F). She appears well and is sitting comfortably on the examination table. Cardiopulmonary examination is normal. Examination of the hands shows mild symmetric swelling of the proximal interphalangeal and metacarpophalangeal joints; there is no warmth or erythema. Bilateral knees have a full range of motion, mild tenderness to palpation, and no swelling. Strength and sensation are symmetric and intact throughout, and distal pulses are strong bilaterally. There is a faint, erythematous, reticular rash on both arms and legs. Medication is prescribed and the patient returns a month later for follow-up. The patient says that her symptoms have resolved and she feels "quite good." However, she is concerned about the prognosis of her disease and the possibility of recurrent joint problems. Physical examination reveals complete resolution of the joint swelling. Which of the following is the best response to this patient's concern?

Question

A 16-year-old girl comes to the office due to joint pain lasting several days.  The patient says, "My hands and knees feel stiff when I wake up, and those joints are painful throughout the day."  The symptoms are improving, but she still has significant discomfort with daily activities.  The patient has never before had such symptoms.  A mildly pruritic rash on her face, arms, and legs developed around the same time as the joint symptoms.  Last week, the patient had an upper respiratory infection with fever and myalgias that resolved quickly without intervention.  She has seasonal allergies for which she uses a glucocorticoid intranasal spray as needed.  She does not use tobacco, alcohol, or illicit drugs.  The patient is not in a relationship and has never been sexually active.  Temperature is 37.2 C (99 F).  She appears well and is sitting comfortably on the examination table.  Cardiopulmonary examination is normal.  Examination of the hands shows mild symmetric swelling of the proximal interphalangeal and metacarpophalangeal joints; there is no warmth or erythema.  Bilateral knees have a full range of motion, mild tenderness to palpation, and no swelling.  Strength and sensation are symmetric and intact throughout, and distal pulses are strong bilaterally.  There is a faint, erythematous, reticular rash on both arms and legs. Medication is prescribed and the patient returns a month later for follow-up.  The patient says that her symptoms have resolved and she feels "quite good."  However, she is concerned about the prognosis of her disease and the possibility of recurrent joint problems.  Physical examination reveals complete resolution of the joint swelling.  Which of the following is the best response to this patient's concern?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c0b9_1cd5_8f63_89d054c20c27_MD0005_00 The treatment of viral arthritis is supportive with nonsteroidal anti-inflammatory drugs for symptomatic relief. The prognosis is favorable; symptoms are self-limited and typically resolve within a few weeks. Parvovirus 19-associated arthritis is nonerosive and causes no long-term sequelae. (Choices A and B) Although antibiotics are prophylactic against recurrence in acute rheumatic fever and are used to treat Lyme arthritis, they are not indicated for viral arthritis. (Choice C) Episodic arthritis flare-ups requiring treatment with anti-inflammatory medications are characteristic of systemic lupus erythematosus. Recurring arthropathy is uncommon in parvoviral arthritis. (Choice E) In contrast to viral arthritis, rheumatoid arthritis can cause significant joint deformities without appropriate long-term treatment. Educational objective: Viral arthritis is typically treated with nonsteroidal anti-inflammatory drugs for symptomatic relief. Parvovirus B19-associated arthritis usually resolves within a few weeks with no long-term sequelae. References: Parvovirus infection in early arthritis. (http://www.ncbi.nlm.nih.gov/pubmed/26886687)

A 16-Year-Old Girl Comes to the Office Due to Joint