Overview
Post-streptococcal reactive arthritis (PSRA) is a complication arising from streptococcal throat infections, characterized by arthritis and potentially diverse extra-articular manifestations such as erythema nodosum, livedo reticularis, and cutaneous vasculitis 1.Diagnosis
Clinical Presentation: Arthritis following a streptococcal throat infection, often accompanied by additional symptoms like erythema nodosum, livedo reticularis, and cutaneous vasculitis 1.
Laboratory Tests: Elevated antistreptolysin O (ASO) titer can support the diagnosis 2.
Differential Diagnosis: Careful evaluation to differentiate from other conditions like mucocutaneous lymph node syndrome (MLNS), especially when uveitis is present 2.Management
First-line Treatment: Nonsteroidal anti-inflammatory drugs (NSAIDs) for symptomatic relief of arthritis 1.
Adjunctive Therapy: Prednisone may be indicated for severe complications such as uveitis 2.Special Populations
Pediatrics: PSRA can present with varied clinical manifestations in children, necessitating tailored treatment based on severity 1.Key Recommendations
Perform repeated diagnostic evaluations, including ASO titer, to accurately differentiate PSRA from other post-streptococcal syndromes like MLNS, especially when uveitis is observed (Evidence: Moderate 2).
Initiate treatment with NSAIDs for managing arthritis symptoms in PSRA (Evidence: Expert opinion 1).
Consider prednisone therapy for severe complications such as uveitis, recognizing its contraindication in conditions like MLNS (Evidence: Moderate 2).References
1 Bont L, Brus F, Dijkman-Neerincx RH, Jansen TL, Meyer JW, Janssen M. The clinical spectrum of post-streptococcal syndromes with arthritis in children. Clinical and experimental rheumatology 1998. link
2 Stern MN, Brown EW, McCurdy D, Lehman TJ. Confusion of a poststreptococcal syndrome complicated by uveitis with mucocutaneous lymph node syndrome. Annals of ophthalmology 1985. link