Poststreptococcal Reactive Arthritis (PSRA)

Essential Information

1. PSRA emerges after GAS pharyngitis but is a diverse entity from acute rheumatic fever.
2. Contemplated a specific type of postinfectious arthritis.

Clinical Presentation

1. Onset is 7 to 10 days after streptococcal pharyngitis
   • Bimodal age distribution: peak at ages 8 to 14 years and young adulthood
2. It May be accompanied by low-grade fever
3. Physical signs: nonmigratory, additive oligo- or polyarthritis of the lower extremities.
   • Persistent rather than transient
     • No other major criteria for ARF

Diagnosis and Evaluation

1. In contrast to ARF, rapid streptococcal antigen tests and throat cultures are frequently positive due to the shorter latency period
   • ASO and DNase B titers may be elevated shortly thereafter
2. ESR and CRP are only mildly to moderately elevated
3. Baseline ECG and echocardiogram should be normal

Treatment

1. Penicillin should be given at diagnosis to eradicate GAS infection
2. Secondary penicillin prophylaxis and close clinical observation for carditis are recommended for up to 1 year.
3. Generally, risk of late cardiac disease in PSRA is negligible; if carditis is discovered, the patient should be considered to have had ARF
4. NSAIDs are first line for symptomatic relief Compared with ARF, PSRA is poorly responsive to aspirin and NSAIDs