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Reactive arthritis induced by tonsillitis

S Kobayashi1, N Tamura, T Akimoto

  • 1Department of Rheumatology, Juntendo University School of Medicine, Tokyo, Japan.

Acta Oto-Laryngologica. Supplementum
|January 1, 1996
PubMed
Summary
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Reactive arthritis in adults can follow tonsillitis, presenting with joint pain and inflammation. Prompt treatment, including antibiotics or tonsillectomy, may prevent symptom recurrence.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Immunology

Background:

  • Reactive arthritis is a form of joint inflammation that can occur after an infection elsewhere in the body.
  • Tonsillitis, an inflammation of the tonsils, is a common infection that can be caused by bacteria, such as Streptococcus.
  • Identifying the specific triggers and clinical manifestations of reactive arthritis is crucial for effective management.

Observation:

  • This study observed 13 adult patients who developed reactive arthritis following tonsillitis.
  • Arthritis symptoms, including joint pain and swelling, appeared 7-10 days after tonsillitis onset.
  • Affected joints commonly included wrists, knees, feet, and sternoclavicular joints, with some patients experiencing Achilles tendon pain.

Findings:

  • Synovial fluid analysis in four patients revealed no bacterial growth, indicating sterile joints.

Related Experiment Videos

  • Elevated serum antistreptolysin O (ASO) and/or antistreptokinase (ASK) titers were noted in most patients, suggesting a streptococcal link.
  • Streptococcus was isolated from tonsillar swabs in seven patients, supporting tonsillitis as the inciting event.
  • Human Leukocyte Antigen (HLA) B39 was found in four patients, indicating a potential genetic predisposition (p <0.005).

    • Implications:

    • The findings suggest that tonsillitis, particularly streptococcal tonsillitis, can be a trigger for reactive arthritis in adults.
    • Distinguishing this form of reactive arthritis from other rheumatic diseases is important for appropriate treatment strategies.
    • Antibiotic therapy and tonsillectomy (removal of tonsils) were effective in managing symptoms and preventing recurrence, with all tonsils showing cryptic abscesses.