A journal article on an outbreak of Rubella Rheumatism in urban  areas of Southern Rhodesia in the 1950's

Ritchken, J.

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D ru g s  u sed  in C ard io lo g ica l P ra c tic e  B. A. Bradlow ............................. 49
S om e N u tr itio n  P ro b lem s in C e n tra l
A fr ic a  E. Baker J o n e s ......................... 60
T h e  S ick le -C e ll Ph enom enon  p. Brain ...................................“3
T h e  D ilated  U re te r  R. M. H o n e y ............................. "8
A  C ase o f  C o n g e n ita l A b sen ce  o f th e
A n u s R . T . M ossop ..................................82
A  C ase of P e rfo ra ted  G a stric  U lcer in
an A fr ica n  M ale  //'. II'. Thompson and D. G.R i c e ...................... - - - 84
R u b ella  R h eu m atism  J . R i t c h k e n ...................................... 85
E D IT O R IA L S
M ala ria  R esearch  P ro g ram m e 
N eu ro sis in  D octors 
N ew  Y e a r  H onours 
A  V is it  to  a  F am ou s F a ith h e a le r  
P ro fesso r  C. H. G. M acafee
O b itu a ry — Dr. Aidan Campbell - - - 90
C orresp o n d en ce - ....................... - - 9 1
T h e  Journ al L ib ra ry  - - - - - -  93
87
87
88 
88 
90
B ook  R e v ie w  - - - - — - - 93
N o tice  - ..........................................................94
L a te s t  P h a rm a ce u tica l P rep a ra tio n s  - 95
P U B L IS H E D  M O N T H L Y , A N N U A L  S U B S C R IP T IO N  £2 2s. Od.
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Vor.. 2. N'o. 2. Ff.rruahy, 1956 Tiu. ( ' km kai . Afhhjan 
JoniNu nr Mkdk (m :
Rubella Rheumatism
BY
J. RITCHKFA, M.D..
Salisbury, S. Rhodesia.
Since Gregg’s brilliant researches in 195 J. rubella has been elevated from the status of a minor illness to one of major importance with far-reaching sequelae. These have assumed such significance that it has perhaps been over­looked that rubella on occasion can result in a severe illness and be followed by immediate 
complications.
During the winter of 195 1 a widespread rubella outbreak occurred in Salisbury. The resulting illness was severe, particularly amongst young adults. Febrile symptoms were marked, and the patients had severe conjunctivitis and upper respiratory involvement. Temperatures often 
remained elevated for four to five days. The 
superficial lymph glands, mainly the occipital and cervical, became swollen and often remained palpable for weeks after recovery. An interest­ing observation, and the main subject of this paper, was the development of a well marked polyarthritis in seven patients.
All affected patients were adults, six being 
female. All showed the typical features of rubella. The joint pains and swelling appeared on the day following the exanthem in one case, on the second dav in two cases, on the 
fourth day in three and on the fifth day in one. \one had previously suffered from rheumatism 
or acute rheumatic fever.
The clinical picture was similar in all these 
cases. The joints involved were mainly the 
wrist, matacarpophalangeal. interphalangeal. ankle, tarsal and metatarsophalangeal joints. The affected joints were swollen and tender and sometimes reddened. In a typical case some joints were swollen and tender, others were merely painful on movement. The type of joint involvement resembled that of acute rheumatic fever with pain and swelling rapidly passing from one joint to another. However, the 
general reaction was very slight; the tempera­ture ranged from normal to 1010 F.. there was no appreciable tachycardia and no heart involve­ment. The average duration of these arthritic changes was five to seven days. In two patients the affected joints remained painful for three 
weeks.
I i.i.rsTR.vrivE Cases
(1) B.P., female aet .16 years. Sudden onset of shivering, conjunctivitis, enlarged occipital glands, fol­lowed liy the eruption of the macular rash of rubella. \o  sore throat. Thu following day she felt well and the rash was fully developed. On the third day of illness the wrists, ankle and finger joints became very painful ami swollen. On the following day the big toe joints became .-imilarly affected and the swelling had subsided in some of the joints affected earlier. Two days later she appeared to be perfectly well.
(2) D.K.H.. female aet 54 years. Typical rxanthemof rubella with enlarged occipital and other superficial lymph glands. Four days later she felt better, but complained of a very swollen and painful right hand lullnwed by severe pain- in the fingers ami wrist ol the left hand. She also complained of parasthesiae in her fingers. The next day the hands were better, hut both feet were very painful, swollen, hot and reddened. Tenderness was most marked over the metatarsophalan­geal joints. Movement was very limited. This lasted for three days and then slowly improved.
(ID ATI., female aet 52 years. Features ol severe rubella: enlarged occipital glands, marked conjunctival injection, sore throat, no Koplik’s spots, temperature ranged from 100’ F. to 102 F. Persistent dry cough. Macular rash of rubella came out on tile second day of illness. The rash was profuse ami she complained of severe, headache and general body pains. The following day she was much better. Five days after the rash had appeared, and when she had fully recovered, both wrist joints and all her finger joints became painful and swollen. The following day these had improved, hut the swelling anil tenderness had spread to the joints of the ankle and foot. The knees were also painful, lint not swollen. Seven days later -lie had lullv recovered.
(loM M CXT
Modern works of reference mention this rom- |*1 ication of rubella. Perry 1 writes that in some epidemics of rubella this illness is sometimes 
followed seven to ten days later bv an acute polyarthritis resembling acute rheumatic fever. Box 2 in Price's Textbook of Medicine also states that benign polyarthritis has been a feature in 
some outbreaks of rubella. Of the older text­
books consulted, only OsierH mentions that an acute arthritis may rarely develop after rubella.
The first detailed study of this complication 
appears to have been made in 1940 during a 
widespread rubella epidemic in England. Suf- fern 1 described a man aged 17 who complained of swollen and painful knee and midlarsal joints 
one day after the onset of the rash of rubella. 
On the third day the wrists were similarly affected, and on the fourth day the fingers. The joints then cleared up rapidly, though some 
weakness remained. At the same time Hodges 5 reported on four eases of “Brachial neuritis” following rubella. Although this worker con­sidered the complication to he a neuritis, it is
Page F.ishty-F'n e
F ebruary, 1956 RUBELLA RHEUMATISM T he Central African J ournal of Me d i u m
more probable from the case description ilia I the condition was a polyarthritis. Indeed. 
I-'rench,6 writing a short time later, confirmed 
the occurrence of this complication and sug­gested that it was an acute or subacute rheuma­tism. He went further, however, and added 
that these cases were probably due to an antecedent streptococcal infection and that the erythematous rash (viz. scarlet fever) had been 
misdiagnosed as the “ubiquitous rubella." Two further workers, however, soon came forward with impressive figures: Hope-Simpscn 7 found that poyarthritis developed in 25 out of 72 
patients with typical rubella: Loudon8 found this complication in 16 out of 50 cases. A further interesting fact in Loudon’s figures was that 15 of these 16 patients, all adults, were 
women.
'It is interesting that when the first Australian cases of German measles in pregnant women were reported, the question was raised as to 
whether the disease was rubella, since there 
were many cases with severe sore throats and 
swollen joints. As the result of much investiga­tion. particularly by Swan." it was shown that 
the disease was rubella.
In America Bass 10 has seen cases of uncom­plicated rubella in which definite swelling and 
tenderness of the small joints, particularly the fingers were present.
In the cases which have been personally ob­served there has been no doubt as to the diagno­sis of rubella and the possibility of scarlatinal rheumatism or of a septic arthritis could be 
definitely excluded. There appears to be some relationship between the severity of the attack and the development of this complication. The cases observed during the recent Salisbury
epidemic were severe and it is possible that this type of rubella may be more prone to be fol­
lowed by a complicating rheumatism. Front all reports rubella rheumatism appears to be rarely seen in childhood. The fact that the rash 
of rubella can sometimes be scarlatiniform in 
character and can even be followed by desquamation 11 makes the recognition of this syndrome most important. Contrariwise, a pre­ceding rubella may solve the cause of an 
unknown polyarthritis or a suspected case of rheumatic fever.
The arthritis, though well marked and very painful in a few patients, subsided usually with­
in five to seven days and left no sequelae. Aspirin in moderate dosage gave symptomatic relief.
REFERENCES
1. P erry, C. B.: Brit. Kncyrl. Med. Pract., \  ol. 2. p. 136. 2nd Ed. 1950. Butterworth’s Medical Publications, London.
2. Box, C. R.: A Textbook of the Practice of Medi­cine; edited by Price. 7th F.d. 1946. Oxford Medical Publications.
3. Osler, W .: The Principles und Practice of Medi­cine. 12th Ed. Revised by Thomas McCrae. 1929. I). Appleton-Century. New York.
1. S it ee k n  (19401: Lancet, 1. 607.
5. H odges. 0. M. W. (19401: Brit. Med. 1. 548.
6. French . (19401: Brit. Med. ]., 1, 791.
7. H ope-Sim pso .n. R. E. (1940): Brit. Med. }.. 1. 830.
8. Loudon, I. S. L. ( 1953 > : Brit. Med. } . .  1. 1388.
9. Swan. C. & T osterin . A. L. < 1946 • : M. J. Aus­tralia, 1, 645.
10. Bass. M. H. (19521 : Advances in Internal Medicine. 5, 15.
11. W es s e i.h o e h . C.: Rubella, in Modern Practice in Infectious Fevers. Vol. 2. Ed. by H. Stanley Banks. 1951. Butterworth & Co. (Publishers) Ltd.. London.
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Rubella rheumatism

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Rubella rheumatism

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