Title:Post-Streptococcal Reactive Arthritis
Volume: 16
Issue: 1
Author(s): Yasser Bawazir*, Tanveer Towheed and Tassos Anastassiades
Affiliation:
- Department of Medicine, King Abdulaziz University, Jeddah,Saudi Arabia
Keywords:
Post-streptococcal reactive arthritis, acute rheumatic fever, reactive arthritis, streptococcal organism, diagnostic
criteria, corticosteroids.
Abstract:
Introduction: Post-Streptococcal Reactive Arthritis (PSRA) is defined as inflammatory
arthritis of ≥1 joint associated with a recent group A streptococcal infection in a patient who does
not fulfill the Jones criteria for the diagnosis of Acute Rheumatic Fever (ARF).
Methods: In this narrative review, we conducted a systematic search on MEDLINE, EMBASE,
Cochrane Library and Google Scholar using the words poststreptococcal reactive arthritis. The
search covered the time period between 1982 and 2016. The purpose of this review is to summarize
the current state of knowledge of PSRA with respect to the definition, epidemiology, clinical presentation
and treatment. We also summarize the key differences between PSRA, reactive arthritis
(ReA) and ARF.
Results: PSRA has a bimodal age distribution at ages 8-14 and 21-37 years with an almost equal
male to female ratio. Clinically, it causes acute asymmetrical non-migratory polyarthritis, however,
tenosynovitis and small joint arthritis may occur. This disease entity can be associated with extraarticular
manifestations, including erythema nodosum, uveitis and glomerulonephritis. The frequency
of HLA-B27 in PSRA does not differ from that of the normal population, which suggests
that it is a separate entity from ReA. Involvement of the axial skeleton, including sacroiliitis, is uncommon
in PSRA. PSRA tends to occur within 10 days of a group A streptococcal infection, as
opposed to the 2 to 3 weeks delay for ARF. PSRA can be associated with prolonged or recurrent
arthritis, in contrast to ARF, in which arthritis usually lasts a few days to 3 weeks. Treatment usually
involves NSAIDs or corticosteroids.
Conclusion: We summarize clinical features that help differentiate PSRA from ARF and ReA.
First-line treatment options include NSAIDs and corticosteroids. Most cases resolve spontaneously
within a few weeks, but some cases are recurrent or prolonged. There are no published randomized
controlled trials of PSRA.
