Post‐streptococcal reactive arthritis: a clinical and serological description, revealing its distinction from acute rheumatic fever

Abstract

Abstract. Jansen TLThA, Janssen M, de Jong AJL, Jeurissen MEC (Rijnstate Hospital, Arnhem, the Netherlands). Post-streptococcal reactive arthritis: a clinical and serological description, revealing its distinction from acute rheumatic fever. J Intern Med 1999; 245: 261-67.

No increased risk of valvular heart disease in adult poststreptococcal reactive arthritis

“…In the current literature a monthly injection of benzylpenicillin is recommended for adult patients with poststreptococcal ReA, based on the guidelines for ARF (6,7,10). Authorative guidelines for poststreptococcal ReA are lacking; the AHA refers to literature on pediatric poststreptococcal ReA but gives no definite advice regarding adult patients with the disease (26).…”

“…The arthritis seen in poststreptococcal ReA is typically nonmigratory, more severe, and prolonged and usually has a poor response to salicylates, compared with the arthritis in ARF, which is characterized by an exquisite sensitivity to aspirin and a migratory self-limiting disease course (6)(7)(8)(9). Subsequent to the identification of dissimilarities in clinical features between poststreptococcal ReA and ARF, differences in genetic and immunologic characteristics were identified (6,10,11), providing further support for the notion that poststreptococcal ReA and ARF are distinct disease entities.…”

“…Paradoxically, although accumulating data suggest that poststreptococcal ReA and ARF are different in nature, the recommendation to initiate long-term penicillin prophylaxis is similar for both diseases, since the recommendations for poststreptococcal ReA are derived from the recommendations for ARF (a monthly injection of 1.2 million units of benzylpenicillin for 5 years or until adulthood) (6,7,10). In ARF the need for antibiotic prophylaxis is well recognized; carditis occurs in 33% of adults with ARF, and mitral regurgitation is the most frequent valvular abnormality.…”

Scarlet Fever Associated with Hepatitis – A Report of Two Cases

“…In this report, 4/24 (17%) patients with post-streptococcal reactive arthritis developed mild, transient hepatitis. In addition, mild and evanescent abnormalities in liver function tests were seen in 25/39 patients with acute rheumatic fever and antecedent streptococcal infection [8]. The mild clinical course in our two patients did not justify liver biopsy.…”

“…In addition, a variety of other manifestations caused by GABHS infection -including otitis media, sinusitis, mastoiditis, pneumonia, empyema, omphalitis, osteomyelitis, streptococcal toxic shock syndrome and meningitis -have been reported [1]. Although hepatitis has previously been described in association with scarlet fever and other GABHS infections in children and adults, most of these reports are not recent and are not mentioned in standard pediatric or pediatric infectious disease textbooks [2][3][4][5][6][7][8]. We would therefore like to report on two patients who recently presented with this manifestation.…”