Elsevier

Mayo Clinic Proceedings

Volume 75, Issue 2, February 2000, Pages 144-147
Mayo Clinic Proceedings

Original Article
Poststreptococcal Reactive Arthritis in Adults: A Case Series

https://doi.org/10.4065/75.2.144Get rights and content

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.

Section snippets

Patients And Methods

After an inpatient or outpatient episode of care for all patients evaluated at Mayo Clinic Rochester, the final diagnoses are kept in an indexed database. We reviewed this established database for all adult patients evaluated from 1976 to 1998 who had a diagnosis of reactive streptococcal or streptococcus arthritis, arthralgia, or arthritides. The medical records of these patients were reviewed in detail to determine demographic data, antecedent streptococcal infection, laboratory evidence of

Patients

Thirty-five adults with the diagnosis of reactive streptococcal or streptococcus arthritis, arthralgia, or arthritides were initially identified. Of these, 7 patients met Jones criteria for acute rheumatic fever,63 had septic arthritis, and 19 lacked serologic evidence of antecedent streptococcal infection, which is necessary to make a definitive diagnosis of PSReA. Six patients (3 men and 3 women) met all the inclusion criteria. The clinical and laboratory data for these 6 patients are

Discussion

Goldsmith and Long7 first described PSReA in 1982. It was characterized as an illness of acute onset, usually coinciding with or following a recent streptococcal infection, with painful symmetric polyarthritis associated with high antistreptolysin 0 and streptozyme antibody titers. The diagnosis and treatment of 6 adult patients with PSReA are described in this case series.

The distinction between PSReA and ARF is not well defined in the medical literature. It has been suggested that PSReA and

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