Fifth Disease

What is it?

Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement. Fifth disease, also called erythema infectiosum, is a mild viral illness that most commonly affects children. It is called fifth disease because it is the fifth of the five viral rash diseases of childhood (the other four being measles, rubella, chicken pox, and roseola). A child with the disease may have mild cold or flu-like symptoms followed a few days later by a red rash on the cheeks, torso and limbs. Some children with fifth disease may develop joint pain and swelling, but those symptoms don’t last for long.

Adults can also become infected with the virus and develop fifth disease. Adults tend to have a more severe flu-like illness, but seldom develop the rash. Adults with the disease are much more likely than children to develop joint symptoms. These symptoms usually clear up within two weeks, but as many as 10 percent of adults who develop joint pain will have prolonged, sometimes chronic, symptoms.

What are the effects?

Several days after being infected with the virus (usually four to 14 days), a child may develop cold or flu-like symptoms, such as low-grade fever, fatigue and an overall feeling of ill health. After a few days, the child may develop a rash on his face that looks as though his cheeks have been slapped (a “slapped-cheek” rash) as well as a lacy red rash on the torso and limbs. The rash may be itchy, but not in all cases. The rash will resolve in seven to 10 days. About 10 percent of children with fifth disease will also have joint pain and possibly joint swelling.

Adults who are infected usually will have more severe flu-like symptoms, but may not develop the characteristic “slapped-cheek” rash. However, as many as 78 percent of symptomatic adults will develop joint pain and swelling one to three weeks following the initial infection. Joints of the hands, wrists and knees are most commonly affected in a symmetric pattern. Joint symptoms usually resolve in a week or two, but approximately 10 percent of adults with joint symptoms will have prolonged difficulties. Chronic joint pain has been known to last up to nine years.

How is it diagnosed?

A physician usually is able to diagnose fifth disease by seeing the typical rash during an examination. If you are among the few whose joint symptoms have outlasted the rash, or perhaps if you never developed the rash, a blood test can detect antibodies to the virus. However, a specific serologic diagnosis is possible only for a short time because the level of antibodies specific for a recent parvovirus B19 infection is elevated for only two months following the initial infection. After that it is only possible to tell whether the person has ever had parvovirus B19 in their lifetime.

What are the treatment options?

The fever and joint pain that children with fifth disease experience may need no treatment or can be alleviated with acetaminophen or ibuprofen. Adults with joint pain and swelling may need to rest, alter their activities, and take nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Advil) or naproxen sodium (Aleve). In rare cases of prolonged arthritis symptoms, other slow-acting medications may be added. Occasionally people with chronic parvovirus arthritis can benefit from drugs like hydroxychloroquine, but it is rarely necessary.

What resources are available?

The Arthritis Foundation leads the way in helping people with arthritis live better today and create better tomorrows through new treatments, better access and, ultimately, cures. We do this by:

  • Funding life-changing research that has restored mobility in patients for more than six decades
  • Fighting for health care policies that improve the lives of the millions of Americans with arthritis
  • Partnering with families to provide empowering programs and information

If you are diagnosed with fifth disease, some Arthritis Foundation resources that may help you better manage and live with your disease are: