This patient has parvovirus B19 infection, and an NSAID such as ibuprofen is the appropriate initial treatment. This infection most commonly occurs in children and is characterized by acute polyarthritis with symmetric swelling and stiffness, the classic “slapped cheek” rash, and flu-like symptoms. Adults tend to contract the virus from children, but the rash may be absent or atypical in adults. Therefore, diagnosis should be suspected in adults with other characteristic findings as well as exposure to sick children. This patient shows evidence of a symmetric, small joint arthritis of the hands, a pattern consistent with rheumatoid arthritis as well as several forms of viral arthritis, most characteristically the arthritis that accompanies parvovirus B19 infection. This patient is at risk for parvovirus B19 infection given her occupation as an elementary school teacher, and the presence of IgM antibodies for parvovirus is definitive and establishes the diagnosis. Parvovirus B19 infection and its associated arthritis are generally self-limited; therefore, management is symptomatic, and an NSAID such as ibuprofen should alleviate symptoms until the episode resolves.

Azithromycin therapy may be appropriate for treatment of Chlamydia infection associated with reactive arthritis, a form of spondyloarthritis associated with a specific group of urogenital and gastrointestinal pathogens. However, antibiotic therapy is not indicated for parvovirus B19 infection.

Interferon alfa is of value for treating some viruses, particularly hepatitis. However, this agent is not needed to treat parvovirus B19 infection, which is self-limited.

Glucocorticoid therapy is not indicated in uncomplicated parvovirus B19 infection due to the self-limited nature of the infection and associated arthritis.