Rubella and juvenile chronic arthritis

Prospective immunological assessment of arthritis induced by rubella vaccine

A prospective study was carried out to correlate the development of joint symptoms after rubella immunization with pre- and post-immunization rubella-specific immunological responses. Arthralgia or arthritis or both occurred in 10 of 37 adult female volunteers at a mean time of 17.0 days after immunization with the RA 27/3 rubella vaccine. All individuals studied before immunization were seronegative for rubella by either the hemagglutination inhibition or the single radial hemolysis technique. In contrast, rubella enzyme-linked immunosorbent assay or lymphoproliferative responses or both were positive in 27 of 37 (73%) individuals tested before receiving the vaccine. Rubella enzyme-linked immuno-sorbent assays carried out before immunization were positive at high levels (mean E = 0.536) in four individuals who developed recurrent episodes of arthritis after administration of the vaccine while remaining at low levels preimmunization in subjects who developed transient arthralgia (E = 0.238) or no joint manifestations at all (E = 0.288). These data provide preliminary evidence suggesting that rubella vaccine-associated arthritis may occur as a consequence of secondary, rather than primary, infection with rubella virus and that the presence of circulating, nonneutralizing rubella antibody may enhance the development or severity (or both) of the associated postinfection joint manifestations. Assessment of rubella hemagglutination inhibition, hemagglutination inhibition (immunoglobulin M), and enzyme-linked immunosorbent assay serological responses at 6 weeks and 6 months post-immunization revealed no significant differences between patients who developed and those who did not develop joint manifestations. Rubella lymphoproliferative responses were elevated at 6 weeks post-immunization in the group developing arthralgia or arthritis or both, with no difference between the groups observed at 6 months post-immunization.

Fate of herpes simplex virus in lymphocytes from blood and joint effusions of systemic and pauciarticular juvenile chronic arthritis

The fate of herpes simplex virus (HSV) in the lymphocytes of patients with juvenile chronic arthritis (JCA) was studied by previously described methods. Lymphocytes isolated from blood and joint effusions of 18 patients with systemic JCA and 11 patients with pauciarticular JCA usually supported viral growth normally.

Chronic arthritis associated with the presence of intrasynovial rubella virus

In this report we present 21 instances in which live rubella virus was isolated from synovial fluid obtained from 6 cases of inflammatory oligoarthritis or polyarthritis over a period of 2 years in the absence of firm clinical evidence of rubella. In 3 cases (cases 1, 2, 6,) a persistent oligoarthritis predominantly affecting the knee joints occurred in 2 adult women and one man, lasting to date 27, 29, and 18 months respectively, and in one of these cases virions were found in cells of the synovial membrane. In case 3 a boy of 9 presented with an illness indistinguishable from the systemic variety of juvenile chronic arthritis (Still's disease). In case 4 a young man with persistent monoarthritis was found to have ankylosing spondylitis, and in case 5 a progressive erosive polyarthritis developed 5 years after an attack of rubella complicated by rubella arthritis. The virus was identified by a variety of virological techniques and infection confirmed by immunofluorescence and (in one case) electron microscopy.

Isolation of rubella virus from synovial fluid in five cases of seronegative arthritis

A cytopathic agent indistinguishable from rubella virus was isolated from the synovial fluid of five patients (two male and three female). In two patients isolations were made on two separate occasions, and in two others on five separate occasions. The patients ranged in age from 9-58 years, and they presented with a variety of clinical syndromes. In particular, none had clinical features suggestive of recent rubella infection; but most cases had very high serum rubella haemagglutination inhibition titres. The identity of the cytopathic agent was shown by a variety of virological techniques to be rubella virus.