Post-streptococcal reactive arthritis: where are we now.

Area of Science:

• Rheumatology
• Infectious Diseases
• Internal Medicine

Background:

• Reactive arthritis can manifest following various infections.
• Streptococcal infections are increasingly recognized in adult populations.
• Distinguishing reactive arthritis from other conditions like Lyme disease is crucial.

Observation:

• A 35-year-old man presented with polyarthritis and constitutional symptoms after tick bites, initially treated unsuccessfully for Lyme disease.
• Strongly positive streptococcal serology was detected.
• Clinical and echocardiographic evaluation showed no cardiac involvement, and immunological screening for inflammatory arthritis was negative.

Findings:

• The patient was diagnosed with post-streptococcal reactive arthritis (PSRA) based on polyarthritis and serological evidence of streptococcal infection, despite lacking other Jones criteria for acute rheumatic fever.
• The patient responded well to penicillin therapy.
• The patient was initiated on oral penicillin prophylaxis.

Implications:

• This case highlights the importance of considering PSRA in adult patients with unexplained arthritis and recent streptococcal infections.
• The findings suggest that penicillin therapy is effective for PSRA.
• There is a need for updated guidelines for the treatment and antibiotic prophylaxis of PSRA in adults, given the rise in adult streptococcal infections.