Post-Streptococcus Reactive Arthritis

 PSRA Defined by:

 Arthritis post GAS-infection
 not fulfilled ARF John’s criteria, or with no other major manifestation.
 Less dramatic response to NSAID compare to ARF
 Age onset 8-14 and 21-37 years 
 F=M
 Clinical Finding:  Treatment:
 Arthritis  NSAID
 Monoarthritis / Polyarthritis  Corticosteroid
 Small/Large/Axial
 No migratory, asymmetrical
 Extraarticular manifestations:
erythema nodosum
uveitis
glomerulonephritis.
 Post-Streptococcus Reactive Arthritis
Author/Year of Sample 4 variable were concluded:
publication ARF PSRA
J Barash*1,7, E Between 1996 and 2005:
Mashihach1, P Navon- - ESR higher lower
Elkan2, Y Berkun3, L - 68 patients with ARF
Harel4, T Tauber5, S - 159 patients with
Padeh3, PJ Hashkes6 and PSRA - CRP higher lower
Y Uziel1
- Resolution after anti-
quick slow
Published: 15 September inflammation
2008 - A relapse after cessation of 7% 21%
anti-inflammatory therapy (meaning:
Pediatric Rheumatology require longer
2008, 6(Suppl 1):P198 anti-inflam
treatment)

- Differentiation of post streptococcal reactive arthritis from acute rheumatic fever. ublished: 15 September 2008 Pediatric
Rheumatology 2008, 6(Suppl 1):P198
Erythema Nodosum
 Erythema Nodosum
 Description:  Diagnosis: clinical, rarely biopsy.
 Acute-onset eruption
 Red or purplish in color  Therapeutic:
 Painful  Underlying aetiology
 Most often Anterior Lower Extremity.  Symptomatic treatment
 Idiopathic or Secondary  NSAID /Corticosteroid
 Associated with:
 Sarcoidosis
 Rheumatological disorders
 Inflammatory bowel disease
 Infections
 Autoimmune disorder
 Drug reactions – especially to sulfonamides and
the oral contraceptive pill
 Malignancies
 Pregnancy
 ARF vs JIA
Symptoms ARF PSRA JIA
- ATCD Strep infection YES YES No
- Latency period from 2-3 wks < 10 days No
infection-Arthritis

- Arthritis:
. Symmetry No No YES
. Migratory Yes No No
. Affected bone Large bone Large/Small/Axial Large/Small/Axial
. Duration Short Short Prolong

- Skin abnormality Subcutaneous Nodule Erythema Nodosum Evanescent rash

- Respond to NSAID Quicker Slow Slow
- Myocarditis/Valvulitis 50% 5% Up to 6%
- ASO titer YES YES 30%
- Prophylaxis ABT YES YES N/A
References:
 Poststreptococcus Reactive Arthrtis, Yasser Bawazir*, Tanveer Towheed and Tassos
Anastassiades. Volume 16, Issue 1, 2020.
 Differentiation of post streptococcal reactive arthritis from acute rheumatic fever.
ublished: 15 September 2008 Pediatric Rheumatology 2008, 6(Suppl 1):P198
 Textbook of PEDIATRIC RHEUMATOLOGY 7th edition, 2011
 Mechanisms of clinical signs / Mark Dennis, William Talbot Bowen, Lucy Cho, © 2012
Elsevier Australia