Poststreptococcal reactive arthritis in children: a potential predecessor of rheumatic heart disease

To report several cases of arthritis seen in children after infection with Group A beta-hemolytic Streptococcus (GABHS) which were not associated with carditis or other major manifestations of the Jones Criteria for acute rheumatic fever (ARF); and to analyze the literature to determine these patients' potential risks for the subsequent development of rheumatic heart disease.

A retrospective chart review was performed of all patients seen in a pediatric rheumatology clinic from January, 1990 to December, 1992.

Four patients were identified with poststreptococcal reactive arthritis (PSReA) and no carditis. Their arthritis had an acute onset, tended to have a longer duration than the arthritis typically seen in ARF, and in most instances did not respond promptly to therapy with aspirin or nonsteroidal antiinflammatory agents. In some patients, there was no history of sore throat or fever. Diagnosis of PSReA was made by serologic testing. Cardiac evaluation in all 4 patients was negative.

PSReA should be considered in the differential diagnosis for any pediatric patient with the acute onset of arthritis, whether the arthritis is the classic migratory polyarthritis typically seen in ARF or not. Throat culture and serologic testing for streptococcal infection should be performed on these patients. If recent GABHS infection is confirmed, cardiac evaluation, including echocardiogram, is warranted. Both ARF and PSReA occur after GABHS infection, but the precise relationship between these 2 entities is unclear. Longterm follow up of pediatric patients with PSReA in previous reports have shown that a certain percentage of them upon subsequent GABHS infection develop carditis. Until the specific risk factors (either host or bacterial characteristics) for developing subsequent carditis are better delineated, antibiotic prophylaxis similar to that used in ARF should be considered in patients with PSReA.