An outbreak of post-streptococcal reactive arthritis

Area of Science:

• Rheumatology
• Infectious Diseases
• Immunology

Background:

• Outbreaks of arthritis following streptococcal infections can mimic other rheumatologic conditions.
• Distinguishing post-streptococcal reactive arthritis (PSRA) from acute rheumatic fever (ARF) is crucial for appropriate management.
• Elevated antibody titers to streptococcal antigens are key diagnostic markers.

Purpose of the Study:

• To describe an outbreak of arthritis associated with high antideoxyribonuclease B (ADNB) titers.
• To differentiate this condition from acute rheumatic fever based on clinical and serological findings.
• To characterize the clinical presentation and outcomes of post-streptococcal reactive arthritis.

Main Methods:

• Retrospective case series of 11 patients presenting with fever and arthritis.
• Clinical evaluation including assessment for carditis and conjunctivitis.
• Serological testing for antideoxyribonuclease B (ADNB) and anti-streptolysin O (ASO) titers.
• Microbiological cultures of blood and synovial fluid.

Main Results:

• Eleven patients presented with fever and mono-, pauci-, or polyarticular arthritis.
• High ADNB titers were observed in all patients, with normal or low ASO titers.
• No evidence of carditis was found in 6 patients; one developed rheumatoid factor-negative spondyloarthropathy.
• Concomitant conjunctivitis occurred in two patients; one had endogenous endophthalmitis.

Conclusions:

• The described outbreak represents post-streptococcal reactive arthritis (PSRA), not acute rheumatic fever.
• High ADNB titers without carditis are indicative of PSRA.
• PSRA can present with diverse articular manifestations and may lead to spondyloarthropathy.