Post-Streptococcal Reactive Arthritis

Bawazir, Yasser; Towheed, Tanveer; Anastassiades, Tassos

doi:10.2174/1573397115666190808110337

Cited by 16 publications

(12 citation statements)

References 25 publications

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“…are associated with reactive arthritis [ 37 – 39 ]. Similarly, it is well established that Streptococcus genus infection is associated with reactive arthritis [ 40 ], although it is not HLA-B27-associated, and it appears not to be a form of spondyloarthritis. It follows that despite the divergence of the AS and IBD microbiomes, a small number of pathogenic genera may be the shared/common factors initially triggering disease.…”

Section: Discussionmentioning

confidence: 96%

Distinctive gut microbiomes of ankylosing spondylitis and inflammatory bowel disease patients suggest differing roles in pathogenesis and correlate with disease activity

Sternes

Phipps

et al. 2022

Arthritis Res Ther

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Background Multiple studies have confirmed dysbiosis in ankylosing spondylitis (AS) and inflammatory bowel disease (IBD); however, due to methodological differences across studies, it has not been possible to determine if these diseases have similar or different gut microbiomes. Results In this study, faecal and intestinal biopsies were obtained from 33 Australian AS patients (including 5 with concomitant IBD, ‘AS-IBD’), 59 IBD patients and 105 healthy controls. Stool samples were also obtained from 16 Italian AS patients and 136 Swedish AS patients. Focusing on the Australian cohort, AS, AS-IBD and IBD patients differed from one another and from healthy controls in both alpha and beta diversity. AS patients with and without clinical IBD could be distinguished from one another with moderate accuracy using stool microbiome (AUC=0.754). Stool microbiome also accurately distinguished IBD patients from healthy controls (AUC=0.757). Microbiome composition was correlated with disease activity measured by BASDAI and faecal calprotectin (FCP) levels. Enrichment of potentially pathogenic Streptococcus was noted in AS, AS-IBD and IBD patients. Furthermore, enrichment of another potentially pathogenic genus, Haemophilus, was observed in AS, AS-IBD, IBD, AS patients with increased BASDAI, and IBD patients with faecal calprotectin >100 μg/mg. Apart from these genera, no other taxa were shared between AS and IBD patients. Conclusions In conclusion, the distinct gut microbiome of AS and AS-IBD patients compared to IBD patients and healthy controls is consistent with immunological and genetic evidence suggesting that the gut plays a different role in driving AS compared with IBD. However, enrichment of two potentially pathogenic genera in both diseases suggests that the presence of a shared/common microbial trigger of disease cannot be discounted.

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Section: Discussionmentioning

confidence: 96%

Distinctive gut microbiomes of ankylosing spondylitis and inflammatory bowel disease patients suggest differing roles in pathogenesis and correlate with disease activity

Sternes

Phipps

et al. 2022

Arthritis Res Ther

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“…In spite of the presence of cardiac involvement in children with PSRA, there is no increased risk of valvular heart disease in adult patients. [ 8 ] In our series, 5 patients with additive oligoarthritis/polyarthritis and lacking of extra-articular or cardiac involvement were unable to match the initial ARF criteria. Although pharyngitis is an early manifestation of adult-onset Still’s disease, [ 11 ] there is no laboratory evidence of GAS infection.…”

Section: Discussionmentioning

confidence: 77%

“…Three had 1 major/1 minor and 2 patients had 2 minor manifestations, not matching the initial ARF criteria but fulfilling the post-streptococcal reactive arthritis (PSRA) diagnosis. [ 8 ] All patients received NSAIDs and antibiotics therapy. Despite not under secondary antibiotics prophylaxis, no carditis was identified during their follow-up of 2.1 to 13.6 years (6.5 ± 4.6).…”

Section: Resultsmentioning

confidence: 99%

“…[ 7 ] Notably, PSRA is a distinct entity, distinguished from ARF as a separate disease. [ 8 ] It usually begins within 10 days following GAS infection and presents with additive and prolong natures, while ARF-related polyarthritis typically has a longer latency with migratory and transitory characters. In spite of the presence of cardiac involvement in children with PSRA, there is no increased risk of valvular heart disease in adult patients.…”

Section: Discussionmentioning

confidence: 99%

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Acute rheumatic fever in adult patients

et al. 2022

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Acute rheumatic fever (ARF) is considered as a disorder of children, and attacks in adults are usually a recurrence of disease acquired in the child’s life. Although the incidence of ARF in children has a decreasing trend in developed countries, resurgent and sporadic epidemics still occur in adults. The first attacks of ARF in adult patients without a childhood history can lead to a diagnostic dilemma. A medical record review in adults at least 18 years of age with an arthralgia complaint fulfilling 2015 revised Jones criteria was performed from January 1, 2000 to December 31, 2019. Eleven ARF patients were identified, including 8 with initial attacks (6 females aged 26–42 years, 33.9 ± 5.3) and 3 pre-existing valvular heart disease with recurrent attacks (2 females aged 38–52 years, 45.0 ± 7.0). In addition to febrile pharyngitis and migratory polyarthritis in initial attacks, pericarditis was encountered in 1, valvulitis in 2, prolong PR interval in 3 and skin involvement in 2 patients with erythema marginatum and IgA vasculitis. All responded to antibiotics and nonsteroidal anti-inflammatory drugs therapy with normalized clinical and laboratory abnormalities, no new-onset carditis, and no recurrent disease during a long-term follow-up (3.8–19.8 years, 12.7 ± 5.4). A sporadic occurrence of adult ARF is observed in southern Taiwan. This disease should be considered by physicians for the differential diagnosis of febrile pharyngitis with arthritis and/or carditis in adults, even in areas with a low incidence of ARF.

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“…None of the patients examined had residual joint damage or deformity. Axial skeleton involvement, such as sacroiliitis, is uncommon in patients with PSRA (Table 2) [45,46]. Arthritis of the sternoclavicular joints was noted in our patients [44].…”

Section: Extra-articular Symptomsmentioning

confidence: 86%

Expanding the spectrum of reactive arthritis (ReA): classic ReA and infection-related arthritis including poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA

et al. 2021

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Reactive arthritis (ReA) is a form of sterile arthritis that occurs secondary to an extra-articular infection in genetically predisposed individuals. The extra-articular infection is typically an infection of the gastrointestinal tract or genitourinary tract. Infection-related arthritis is a sterile arthritis associated with streptococcal tonsillitis, extra-articular tuberculosis, or intravesical instillation of bacillus Calmette–Guérin (iBCG) therapy for bladder cancer. These infection-related arthritis diagnoses are often grouped with ReA based on the pathogenic mechanism. However, the unique characteristics of these entities may be masked by a group classification. Therefore, we reviewed the clinical characteristics of classic ReA, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA. Considering the diversity in triggering microbes, infection sites, and frequency of HLA-B27, these are different disorders. However, the clinical symptoms and intracellular parasitism pathogenic mechanism among classic ReA and infection-related arthritis entities are similar. Therefore, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA could be included in the expanding spectrum of ReA, especially based on the pathogenic mechanism.

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Post-Streptococcal Reactive Arthritis

Cited by 16 publications

References 25 publications

Distinctive gut microbiomes of ankylosing spondylitis and inflammatory bowel disease patients suggest differing roles in pathogenesis and correlate with disease activity

Distinctive gut microbiomes of ankylosing spondylitis and inflammatory bowel disease patients suggest differing roles in pathogenesis and correlate with disease activity

Acute rheumatic fever in adult patients

Expanding the spectrum of reactive arthritis (ReA): classic ReA and infection-related arthritis including poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA

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