Post Streptococcal Reactive Arthritis

Post Streptococcal Reactive Arthritis

Post streptococcal reactive arthritis has a lower latency of about 1 week after the streptococcal infection, unlike the usual delay of about three weeks with rheumatic fever. PSRA responds poorly to treatment with salicylates unlike rheumatic fever. It is often difficult to differentiate PSRA from rheumatic fever without carditis.

In one series of 12 cases, none had carditis or received prophylactic antibiotic therapy during average follow up period of 17 months (range 6 – 42 months). One of these patients developed classic acute rheumatic fever with valvulitis one and a half years after the initial episode. Two had additional episodes of arthritis and another had arthralgia. The authors felt that post streptococcal arthritis is part of the spectrum of rheumatic fever and should be considered for prophylactic antibiotic therapy [1].

Flitting nature of arthritis is not common in PSRA while it is common in acute rheumatic fever. Rather in PSRA it is persistent arthritis. Small joint involvement is rare in acute rheumatic fever while it is common in PSRA. Deforming arthritis is usually not a feature of acute rheumatic fever while it may occur with PSRA [2].

A narrative review published in 2020 mentioned that PSRA has a bimodal age distribution at ages 8-14 and 21-37 years with an almost equal male to female ratio [3]. First line treatment options mentioned were NSAIDs and corticosteroids. While most cases resolve spontaneously within a few weeks, some may be recurrent or prolonged. They mentioned that PSRA could be associated with extraarticular manifestations like erythema nodosum, uveitis and glomerulonephritis.

References

1. C L De Cunto, E H Giannini, C W Fink, E J Brewer, D A Person. Prognosis of Children With Poststreptococcal Reactive Arthritis. Pediatr Infect Dis J. 1988 Oct;7(10):683-6.
2. Infectious Diseases and Immunization Committee. Poststreptococcal Arthritis. Can J Infect Dis. 1995 May;6(3):133-5.
3. Bawazir Y, Towheed T, Anastassiades T. Post-Streptococcal Reactive Arthritis. Curr Rheumatol Rev. 2020;16(1):2-8. doi: 10.2174/1573397115666190808110337. PMID: 31393253.