Post streptococcal reactive arthritis in children: varied presentations, differentiationfrom acute rheumatic fever and antibiotic prophylaxis

Abstract

Post streptococcal reactive arthritis (PSRA) refers to inflammation of one or more joints soon after streptococcal throat infection without a demonstrable presence of the organisms in the joint. We present here, two children with very different forms of PSRA. While the first child had axial and appendicular joint involvement in non-migratory pattern that persisted for a long time with intermittent exacer bation without carditis and with no preceding clinically apparent throat infection,the second child presented with throat infections followed by involvement of knee joints alone in episodic and migratory patterns with disease free intervals in between, but with evidence of mild carditis. Clinical suspicion and close attention to the differentiating features from acute rheumatic fever (ARF) are necessary to arrive at the appropriate diagnosis which could at times be challenging. The need for long term follow up is emphasized as the former child was noted to evolve into enthesitis related arthritis. Presented is a review of differentiating features between ARF and PSRA and the role of antibiotic prophylaxis.