Poststreptococcal Reactive Arthritis

Aka: Poststreptococcal Reactive Arthritis, Post-streptococcal Reactive arthritis

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II. Epidemiology

  1. Peak ages affected
    1. Ages 8 to 14 years old
    2. Ages 21 to 37 years old

III. Pathophysiology

  1. Autoimmune response to Group A Streptococcus
  2. Onset 7-10 days after Group A Streptococcal Pharyngitis
  3. May occur with or without Rheumatic Fever
    1. Part of Jones Criteria for Rheumatic Fever diagnosis

IV. Symptoms

  1. Persistent or recurrent non-Migratory Arthritis
  2. Distribution
    1. Most commonly affects hip, knee, ankle and wrist

V. Labs

  1. Complete Blood Count (CBC)
  2. Acute phase reactants (lower levels than with Rheumatic Fever)
    1. Erythrocyte Sedimentation Rate (ESR)
    2. C-Reactive Protein (C-RP)
  3. Streptococcus Testing
    1. GAS Rapid Antigen test with reflex to Throat Culture if negative
    2. ASO Titer

VI. Differential Diagnosis

  1. Septic Arthritis
    1. Always exclude in Monoarthritis
  2. Rheumatic Fever
    1. Arthritis with other Rheumatic Fever criteria (see Jones Criteria)
  3. Viral Arthritis
  4. Reactive Arthritis

VII. Management

  1. Antiinflammatory medications
    1. NSAIDs and Aspirin are less effective than in the Arthritis of Rheumatic Fever
  2. Monitor for carditis (and Rheumatic Fever)
    1. Monitoring for one year
    2. Benzathine Penicillin G IM monthly for one year

VIII. References

  1. Maness (2018) Am Fam Physician 97(8): 517-22 [PubMed]

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