{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:49:03Z","timestamp":1791568143820,"version":"4.3.4"},"reference-count":34,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,15]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Rubella and parvovirus B19 (B19V) infections can present with arthritis-like symptoms in adults instead of typical dermatological symptoms. We quantify associations between rubella and B19V, respectively, with arthritis-like complications using real-world diagnostic testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional and retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Reference laboratories across the USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Participants with IgM tests for rubella (N=211\u2009917) or B19V (N=644\u2009473) performed at Labcorp from 2014 to 2023. Among these participants, participants with IgM tests for rubella (N=1867) or B19V (N=22\u2009683) and longitudinal laboratory testing through Labcorp were followed for diagnostic tests for rheumatoid arthritis (RA) up to 1.5 years after the viral IgM tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Primary outcomes were arthritis-like suspicions by providers and diagnostic testing for RA-associated biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Higher proportions of suspicions of arthritis (1.4%, p&lt;0.001) and same-day RA-associated diagnostic testing (1.3%, p&lt;0.001) and positivity (26.4%, p=0.003) were identified in rubella IgM-positive adults compared with rubella IgM-negative adults. A higher proportion of B19V IgM-positive adults had suspected arthritis (12.6%) compared with B19V IgM-negative adults (8.1%, p&lt;0.001). While a higher proportion of B19V IgM-positive adults (21.3%) received RA-associated diagnostic testing compared with B19V IgM-negative adults (14.3%, p&lt;0.001), a lower proportion of B19V IgM-positive adults with RA-associated diagnostic testing (12.8%) tested positive (B19V IgM-negative: 15.5%, p&lt;0.001). There was a 33% increased risk of a suspected RA diagnosis in B19V IgM-positive participants compared with B19V IgM-negative participants (HR=1.33, 95%\u2009CI 1.10 to 1.61).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Increased awareness of non-typical RA symptoms may facilitate differential diagnosis between rubella, B19V and RA. Recent B19V infections do not occur concurrently with RA; recent B19V infections should be considered in the differential diagnosis for RA when patients present with polyarticular joint symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103683","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T12:40:39Z","timestamp":1767789639000},"page":"e103683","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Association of rubella and parvovirus B19 IgM positivity and suspected rheumatoid arthritis: a retrospective analysis from a large US national reference laboratory (2014\u20132023)"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9558-4819","authenticated-orcid":false,"given":"Min Kyung","family":"Lee","sequence":"first","affiliation":[{"name":"Labcorp, Burlington, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0465-9131","authenticated-orcid":false,"given":"David","family":"Alfego","sequence":"additional","affiliation":[{"name":"Labcorp, Burlington, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley J","family":"Naides","sequence":"additional","affiliation":[{"name":"Labcorp, Burlington, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"2026010704403339000_16.1.e103683.1","unstructured":"Morales M , Lanzieri T , Reef SE . 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