Post-streptococcal reactive arthritis [PSRA]: Clinical features and risk of carditis

ABSTRACT

Post-streptococcal reactive arthritis [PSRA] is a poorly understood clinical syndrome in which oligoor polyarthritis occurs following a group Astreptococcal pharyngitis. There is lack of universally accepted guidelines for diagnosis and management of these patients. Long-term data regarding risk of carditis within this population are insufficient. To study the clinical features, risk of subsequent carditis and the need for prophylactic antibiotics in this population. Forty-five patients with the diagnosis of PSRA w e re identified at the pediatric immunology clinic in King Hussein Medical Center, Jordan between January 1999 and April 2003. They all had evidence of preceding streptococcal infection and joint disease at initial presentation. However, none fulfilled the updated revised Jones criteria for diagnosis of acute rheumatic fever [ARF]. Common viral causes of reactive arthritis were excluded and all patients had cardiac evaluation at presentation. Follow up was for a minimum of two years, focusing on clinical recurrences and the clinical and/or echocardiographic evidence of carditis. Forty patients, 21 male and 19 female, aged between six and 17 years with a mean age of 10 years were included in the follow up study. All patients had persistent arthritis lasting 2-6 weeks at presentation, which did not respond to conventional therapy with salicylates. Symmetrical polyarthritis of large joints was predominant. Small and axial joints were involved in 45% and 33% cases respectively. Cardiac evaluation at initial presentation was normal. They all had evidence of preceding group Astreptococcal infection. During follow up, four patients developed evidence of carditis with recurrence of arthritis. They were found to be noncompliant with prophylactic antimicrobials. Post-streptococcal reactive arthritis may be considered a separate entity from acute rheumatic fever. However, because of the risk of subsequent carditis in certain percentage of patients, we recommend long-term antimicrobials prophylaxis as advised for patients with acute rheumatic fever