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Post Streptococcal Arthritis

  • Post-streptococcal reactive arthritis (PSRA). In some parts of the world, there are reports of patients who develop arthritis following streptococcal infections and do not fulfil Jones criteria for Acute Rheumatic Fever (ARF). Such patients are observed to have distinct clinical, laboratory, immunologic and genetic features and these patients are labelled to have post-streptococcal reactive arthritis (PSRA). Some of them do develop carditis leading to the belief that this entity is merely at one end of the spectrum of ARF.
  • However in countries endemic for ARF, and especially in at risk populations, it is recommended that PSRA as a diagnosis is made with caution and only after consultation with paediatrics, infectious diseases and rheumatology.
  • The important differences between ARF and PSRA are highlighted below.

Comparison Post-Streptococcal Reactive Arthritis (PSRA) &  Acute Rheumatic Fever (ARF)

 

PSRA

ARF

Age.

Bimodal: 8-14 years and 21-37 years.

5-15 years with peaking around 12 years.

Disease onset following streptococcal infection.

7-10 days (short).

10-28 days (longer).

Joint involvement.

Additive and persistent; large, small and axial joints.

Migratory, transient; large joints.

Acute phase reactants.

Moderate elevation.

Marked elevation.

Response of arthritis to NSAIDs. 

Poor to moderate.

Dramatic.

 

Carditis.

Conflicting reports, but uncommon.

Major diagnostic criterion, between 60-70%.

Antibiotic prophylaxis.

For one year if echocardiogram is normal.

Long-term secondary antibiotic prophylaxis.

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