I would like to add a few statements based on my clinical experience.
Clinical features: Facial flushing and redness is common during initial phase. Skin rash such as small red dots are seen as the fever subsides. Red patches are also observed. As the red patches dissappear intense itching has been observed. Occasionally swelling of the forearm or leg underlying this rash is seen,sometimes mistaken for infection:cellulitis. The arthritis also follows a saddle back pattern. the first episode is with fever followed by a period during which patient is pain free. Around 18-20 days later intense joint pain recurs usually ankle, wrist and knees. This can last 4-8 months. Few patients develop Rheumatoid arthritis with swelling in the small joints of the hand
Steroids may be required in these cases. Low total count is observed more frequently. Usually in the range of 3500-4000 cell/cumm
Proteins in the urine may also be observed during the acute phase.
If the joint pain persists beyond 2-3 months,patients should see a rheumatologist to rule out early Rheumatoid arthritis