74 Brochures Health Education
Tabled Paper 2134
Tabled Papers for 6th Assembly 1990 - 1994; Tabled Papers; ParliamentNT
Tabled by Mike Reed
Made available by the Legislative Assembly of the Northern Territory under Standing Order 240. Where copyright subsists with a third party it remains with the original owner and permission may be required to reuse the material.
synovial fluid. It is rarely practicable to identify the virus, but the clinical outcome is similar. (j) Recent work has shown that a rickettsial disease, possibly Queensland tick-borne typhus, can be acquired in eastern Australia as far south as Gippsland, the Fumeaux group of islands in Bass Strait, and Tasmania (B. Dwyer, personal communication). Fever and constitutional symptoms are commonly more intense than in EPA; the rash, which can involve the palms and soles, may also be accompanied by an eschar at the site of tickbite; and the pains in the limbs are more likely to appear as myalgia or arthralgia rather than frank arthritis. Antibody tests for R. australis should be requested if there is any likelihood of this condition. (k) Henoch-Schonlein disease can be indistinguishable if purpura is extensive. Abdominal pain does not occur in RRV disease. (1) Drug reactions, erythema multiforme or a serum-sickness type of reaction might be in question. The writer has not seen a definite urticarial element in the rash of RRV disease. (iii) Diagnosis in chronic phase This cannot be considered exhaustively here but it can generate diagnostic headaches for the doctor and anxiety for the patient, which may be partly resolved by the current developments in serology referred to earlier. The difficulties at this stage of the illness provide a compelling reason to establish the diagnosis in the acute phase whenever the opportunity arises. Nevertheless patients do present in the chronic stage for the first time, with morning stiffness, pain, tenderness and slight swelling in the small joints of the hands, more or less symmetrical, or with recurrent effusions in one or more large joints. Without a history of rash, rheumatoid disease, systemic lupus, and the reactive group of arthritides (e.g. Reiter's syndrome) may each need to be considered according to the presenting features. Unless unrelieved pain or undue anxiety is allowed to promote disuse and secondary contractures, RRV disease does not cause permanent derangement of joints. (a) The development of erosive changes in X-rays or fixed deformities should therefore put the diagnosis in doubt. (b) A persistently raised ESR should do likewise. (c) Persistent symptoms in the spine, sacroiliac or hip joints also point to som e other cause. (d) Distinctly and persistently monoarticular arthritis is not compatible with the diagnosis. 11
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