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Poststreptococcal reactive arthritis.

Stanford T Shulman1, Elia M Ayoub

  • 1Department of Pediatrics, Northwestern University, Feinberg School of Medicine, The Children's Memorial Hospital, Chicago, Illinois 60614-3394, USA. sshulman@northwestern.edu

Current Opinion in Rheumatology
|August 23, 2002
PubMed
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Poststreptococcal reactive arthritis (PSRA) is an arthritic condition following a streptococcal infection. It presents with persistent joint inflammation and requires specific management to prevent potential cardiac complications.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Immunology

Background:

  • Poststreptococcal reactive arthritis (PSRA) is a distinct condition following group A streptococcal infections.
  • It does not meet diagnostic criteria for acute rheumatic fever.
  • PSRA exhibits unique clinical and immunological characteristics.

Purpose of the Study:

  • To define the clinical and diagnostic features of PSRA.
  • To identify associated genetic markers.
  • To recommend appropriate management strategies, including prophylaxis.

Main Methods:

  • Clinical case review and analysis.
  • Serological testing for recent group A streptococcal infection.
  • Human Leukocyte Antigen (HLA) typing.

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Main Results:

  • PSRA is characterized by additive, persistent arthritis (mean 2 months) poorly responsive to NSAIDs.
  • Elevated acute phase reactants and serological evidence of recent streptococcal infection are common.
  • Association with HLA-DRB1*01, not HLA-B27.
  • Up to 6% of patients develop mitral valve disease.

Conclusions:

  • PSRA is a specific post-infectious arthritis with identifiable features.
  • Genetic predisposition involves HLA-DRB1*01.
  • A 1-year course of antistreptococcal prophylaxis is recommended, with discontinuation if no cardiac involvement is observed.