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Poststreptococcal reactive arthritis in adults: a case series
R J Aviles1, G Ramakrishna, D N Mohr
1Department of Internal Medicine, Mayo Clinic Rochester, Rochester, MN 55905, USA.
Mayo Clinic Proceedings
|February 23, 2000
Summary
Poststreptococcal reactive arthritis (PSReA) in adults presents with disproportionate joint symptoms and requires NSAIDs or corticosteroids for treatment. Penicillin prophylaxis is not currently supported for PSReA.
Area of Science:
- Rheumatology
- Infectious Diseases
- Internal Medicine
Background:
- Poststreptococcal reactive arthritis (PSReA) is a distinct clinical entity following streptococcal infection.
- Differentiating PSReA from acute rheumatic fever (ARF) is crucial for appropriate management in adults.
Purpose of the Study:
- To provide guidance for primary care physicians on diagnosing and treating adult patients with PSReA.
- To characterize the clinical presentation, diagnostic markers, and treatment outcomes of PSReA in adults.
Main Methods:
- Retrospective review of adult patients diagnosed with reactive streptococcal arthritis at Mayo Clinic between 1976 and 1998.
- Exclusion of patients with ARF, septic streptococcal arthritis, or nonspecific reactive arthritis.
Main Results:
- Six adult cases of PSReA were identified, presenting with polyarthritis and oligoarthritis disproportionate to physical findings.
- Elevated anti-DNase B and antistreptolysin O titers confirmed recent streptococcal infection, despite negative throat cultures.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) provided partial to full symptomatic relief in all patients, unlike aspirin. Corticosteroids offered relief in some cases.
Conclusions:
- PSReA should be considered in the differential diagnosis of adult arthritis.
- Treatment typically involves NSAIDs and potentially corticosteroids.
- Current evidence does not support the use of penicillin prophylaxis for adult PSReA.