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Natural history of Ross River virus-induced epidemic polyarthritis

Med J Aust 2002; 177 (7): 356-360.

Summary

Objective: To describe the natural history, treatment and cost of Ross River virus-induced epidemic polyarthritis (RRV disease).

Design: Questionnaire-based longitudinal prospective study.

Participants and setting: Patients in the greater Brisbane area, Queensland, diagnosed with RRV disease by their general practitioners based on clinical symptoms and paired serological tests between November 1997 and April 1999.

Main outcome measures: Scores on two validated quality-of-life questionnaires (Clinical Health Assessment Questionnaire and Medical Outcomes Study Short Form 36) were obtained soon after diagnosis and one, two, three, six and 12 months thereafter. Scores were compared between patients diagnosed with RRV disease alone and those with RRV disease plus other conditions.

Results: 67 patients were enrolled. Most patients with RRV disease alone had severe acute symptoms, but followed a consistent path to recovery within three to six months. Other conditions, often chronic rheumatic diseases or depression, were identified in half the cohort; their quality-of-life scores suggested stable chronic illness between six and 12 months after diagnosis. Non-steroidal anti-inflammatory drugs (NSAIDs) were taken by 58% of patients (average use, 7.6 weeks; range, 2–22 weeks). Time off work averaged 1.9 days, and direct cost to the community was estimated as $A1018 per patient.

Conclusions: Symptom duration and frequency of long-term symptoms may have been overestimated by previous studies of RRV disease. Disease persisting six to 12 months after RRV diagnosis was largely attributable to other conditions, highlighting the need to seek other diagnoses in RRV patients with persistent symptoms.

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  • Andrea D Mylonas1
  • Allison M Brown2
  • Tracy L Carthew3
  • David M Purdie4
  • Nirmala Pandeya5
  • Louisa G Collins6
  • Andreas Suhrbier7
  • Barry McGrath8
  • Elizabeth J Reymond9
  • Philip C Vecchio10
  • Ian D Gardner11
  • Ferdinandus J de Looze12

  • 1 Australian Centre for International Health and Nutrition, Queensland Institute of Medical Research, Brisbane, QLD.
  • 2 Queensland Research and Health Promotion Unit, Royal Australian College of General Practitioners, Brisbane, QLD.
  • 3 Department of Rheumatology, Princess Alexandra Hospital, Brisbane, QLD.
  • 4 Department of Immunology, Queensland Medical Laboratory, Brisbane, QLD.
  • 5 University General Practice, University of Queensland, Brisbane, QLD.

Correspondence: andreasS@qimr.edu.au

Acknowledgements: 

We would like to thank the pathology companies Queensland Medical Laboratory and Sullivan and Nicolaides, Brisbane, QLD), Dr F Wolfe (Director, National Data Bank for Rheumatic Diseases, Kansas, USA), Dr J F Farmer (Brisbane), M Harris and Professor B Kay (Queensland Institute of Medical Research, Brisbane) for their contributions. The research was funded by Queensland Health, the Australian Rotary Health Research Fund (Arbovirus Prevention Research Grants), the Australian National Centre for International and Tropical Health and Nutrition, and the Queensland Institute of Medical Research Trust.

Competing interests:

None declared.

  • 1. Fraser JR. Epidemic polyarthritis and Ross River virus disease. Clin Rheum Dis 1986; 12: 369-388.
  • 2. Flexman JP, Smith DW, Mackenzie JS, et al. A comparison of the diseases caused by Ross River virus and Barmah Forest virus. Med J Aust 1998; 169: 159-163.
  • 3. Westley-Wise VJ, Beard JR, Sladden TJ, et al. Ross River virus infection on the North Coast of New South Wales. Aust N Z J Public Health 1996; 20: 87-92.
  • 4. Selden SM, Cameron AS. Changing epidemiology of Ross River virus disease in South Australia. Med J Aust 1996; 165: 313-317.
  • 5. Condon RJ, Rous IL. Acute symptoms and sequelae of Ross River virus infection in South-Western Australia: A follow-up study. Clin Diag Virol 1995; 3: 273-284.
  • 6. Hawkes RA, Boughton CR, Naim HM, Stallman ND. A major outbreak of epidemic polyarthritis in New South Wales during the summer of 1983/1984. Med J Aust 1985; 143: 330-333.
  • 7. Medical Outcomes Study Short Form 36 (SF-36). Available at http://www.hsru.ox.ac.uk/shortfrm.htm Accessed 1997.
  • 8. Arthritis Research Center Foundation. Clinical Health Assessment Questionnaire (CLINHAQ). Available at http://www.arthritis-research.org/clinhaq.htm Accessed 1997.
  • 9. Australian Bureau of Statistics. National health survey Australia, 1995: SF-36 population norms. Canberra, ABS, 1997. (Catalogue No. 4399.0.)
  • 10. Wolfe F, O'Dell JR, Kavanaugh A, et al. Evaluating severity and status in rheumatoid arthritis. J Rheumatol 2001; 28: 1453-1462.
  • 11. McLennan W. Australian social trends 2001. Canberra: ABS. (Catalogue No. 4102.0.)
  • 12. Murtagh JE. General practice. 2nd ed. Sydney: McGraw-Hill. 1998.
  • 13. Australian Bureau of Statistics. Average weekly Australian earnings. Canberra: ABS, 2000. (Catalogue No. 6302.)
  • 14. Keary JP. Review of 103 patients with RRV EPA. In: Abstracts of the Australian Rheumatology Association 40th Annual Scientific Conference. May 1997; Brisbane, QLD. Sydney: ARA, 1997.
  • 15. March LM, Cross MJ, Lapsley H. Outcomes after hip or knee replacement surgery for osteoarthritis. A prospective cohort study comparing patients' quality of life before and after surgery with age-related population norms. Med J Aust 1999; 171: 235-238. <eMJA full text>
  • 16. Klempner MS, Hu LT, Evans J, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 2001; 345: 85-92.
  • 17. Wolfe F, Skevington SM. Measuring the epidemiology of distress: the rheumatology distress index. J Rheumatol 2000; 27: 2000-2009.

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