Advertisement
Mayo Clinic Proceedings Home

Poststreptococcal Reactive Arthritis in Adults: A Case Series

      Objective

      To guide primary care physicians regarding the diagnosis and treatment of poststreptococcal reactive arthritis (PSReA) in adults.

      Patients and Methods

      We retrospectively reviewed an indexed database of all patients evaluated or hospitalized between 1976 and 1998 at Mayo Clinic Rochester and identified 35 patients with the diagnosis of reactive streptococcal arthritis, arthralgia, or arthritides. Twenty-nine patients with the diagnosis of acute rheumatic fever (ARF), septic streptococcal arthritis, or nonspecific reactive arthritis were excluded.

      Results

      PSReA was confirmed in 6 adults (3 women, 3 men; age range, 25–66 years). All patients were symptomatic with polyarthritis and oligoarthritis disproportionate to the objective findings on physical examination. Although all patients had negative throat cultures at the onset of arthritis, increased titers of anti-DNase B and antistreptolysin O confirmed recent streptococcal infection. Antecedent events included pharyngitis in 3 patients (who had received a minimum of a 10-day course of penicillin) and toxic shock syndrome in 1 patient. The latency of onset of arthritis ranged from 4 days to 6 weeks. The arthritic symptoms had a protracted course beyond the typical maximum of 3 weeks described for ARF. Treatment with aspirin did not provide symptomatic relief in any of the patients, whereas the response to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) was at least partial in all cases. Symptomatic relief occurred in 1 patient who received indomethacin and in 1 patient treated with prednisone. Penicillin prophylaxis was recommended in 1 patient.

      Conclusion

      PSReA should be included in the differential diagnosis of all adult patients presenting with arthritis. Treatment strategies include aspirin, other NSAIDs, and corticosteroids. In adult patients with PSReA, there is no evidence to support the use of penicillin prophylaxis at this time.
      ARF (acute rheumatic fever), NSAID (nonsteroidal antiinflammatory drug), PSReA (poststreptococcal reactive arthritis)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jones TD
        The diagnosis of rheumatic fever.
        JAMA. 1944; 126: 481-484
        • Markowitz M
        Evolution and critique of changes in the Jones criteria for the diagnosis of rheumatic fever.
        N Z Med J. 1988; 101: 392-394
        • Moon RY
        • Greene MG
        • Rehe GT
        • Kaiona IM
        Poststreptococcal reactive arthritis in children: a potential predecessor of rheumatic heart disease.
        J Rheumatol. 1995; 22: 529-532
        • Deighlon C
        Beta haemotylic streptococci and reactive arthritis in adults.
        Ann Rheum Dis. 1993; 52: 475-482
        • De Cunto CL
        • Giannini EH
        • Fink CW
        • Brewer EJ
        • Person DA
        Prognosis of children with poststreptococcal reactive arthritis.
        Pediair Infect Dis J. 1988; 7: 683-686
        • Stollerman GH
        • Markowitz M
        • Taranta A
        • Wannamaker LW
        • Whittemore R
        Jones criteria (revised) for guidance in the diagnosis of rheumatic fever.
        Circulation. 1965; 32: 664-668
        • Goldsmith DP
        • Long SS
        Poststreptococcal disease of childhood- a changing syndrome [abstract].
        Arthritis Rheum. 1982; 25: S18
        • Denny FW
        T. Duckctt Jones and rheumatic fever in 1986: T. Duckett Jones Memorial Lecture.
        Circulation. 1987; 76: 963-970
        • Madhuri V
        • Mathai E
        • Brahmadathan KN
        • Korula RJ
        • John TJ
        An outbreak of post-streptococcal reactive arthritis.
        Indian J Med Res. 1997; 105: 249-253
        • Crea MA
        • Mortimer Jr, EA
        The nature of scarlatinal arthritis.
        Pediatrics. 1959; 23: 879-884
        • Fink CW
        The role of the streptococcus in poststreptococcal reactive arthritis and childhood polyarteritis nodosa.
        J Rheumatol. 1991; 18: 14-20
        • Homer C
        • Shulman ST
        Clinical aspects of acute rheumatic fever.
        J Rheumatol. 1991; 18: 2-13
        • Wallace MR
        • Garst PD
        • Papadimos TJ
        • Oldfield III, EC
        The return of acute rheumatic fever in young adults.
        JAMA. 1989; 262: 2557-2561
        • Hicks R
        • Yim G
        Post-streptococcal reactive arthritis (PSRA)-a manifestation of acute rheumatic fever (ARF) [abstract].
        Arthritis Rheum. 1990; 33: S145
        • Gutierrez-Urena S
        • Molina J
        • Molina JF
        • Garcia CO
        • Cuellar ML
        • Espinoza LR
        Poststreptococcal reactive arthritis, clinical course, and outcome in 6 adult patients.
        J Rheumatol. 1995; 22: 1710-1713