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- PSRA emerges after GAS pharyngitis but is a diverse entity from acute rheumatic fever.
- Contemplated a specific type of postinfectious arthritis.
- Onset is 7 to 10 days after streptococcal pharyngitis
- Bimodal age distribution: peak at ages 8 to 14 years and young adulthood
- It May be accompanied by low-grade fever
- Physical signs: nonmigratory, additive oligo- or polyarthritis of the lower extremities.
- Persistent rather than transient
- No other major criteria for ARF
Diagnosis and Evaluation
- 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
- ESR and CRP are only mildly to moderately elevated
- Baseline ECG and echocardiogram should be normal
- Penicillin should be given at diagnosis to eradicate GAS infection
- Secondary penicillin prophylaxis and close clinical observation for carditis are recommended for up to 1 year.
- Generally, risk of late cardiac disease in PSRA is negligible; if carditis is discovered, the patient should be considered to have had ARF
- NSAIDs are first line for symptomatic relief Compared with ARF, PSRA is poorly responsive to aspirin and NSAIDs