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

Objective. To follow-up prospectively patients with arthritis after infecti on with beta-haemolytic streptococci of Lancefield group A (beta HSA),with emphasis on clinical characteristics and serological features, We additiona lly investigated whether these patients, though often fulfilling the Jones' criteria for acute rheumatic fever (ARF), had a disease with clinical char acteristics different from ARE Design. We performed a systematic prospective observational study of consec utive patients at a Dutch Outpatient Clinic and Department of Rheumatology, with arthritis after throat infection with PHSA presenting to rheumatologi st or internist from September 1992 until September 1996, Main outcome meas ures were clinical and biochemical characteristics with special reference t o carditis. Results, A total of 23 patients (21 Dutch, two Turkish: female/male ratio 1 5/8; mean (SD) age 42 (14) years) with predominantly non-migratory arthriti s were included. A positive throat swab culture was obtained in 17%, All pa tients showed a significant rise of antistreptolysine-O (ASO; normal <200 I U mL(-1)) and antideoxyribonuclease-B (anti-DNase-B; normal <200 IU mL(-1)) titre, The mean (SEM) maximal ASO was 1305 (195) IU mL(-1), and anti-DNase -B titre 980 (115) IU mL(-1). Arthritis was present in mean (SEM) 5.4 (0.9) joints: 2.2 (0.7) small, 3.2 (0.4) larger joints. The arthritis was monart icular in 23% of the patients, oligoarticular in 35%, and polyarticular in 43%, Skin abnormalities were present in 12 patients: erythema nodosum in se ven patients (30%), and erythema multiforme in five patients (22%). A trans ient cholestatic hepatitis nas found in four patients (17%), In two patient s a transient first-degree conduction block was found; however, neither ech ocardiography nor clinical course supported carditis, All patients were adv ised to receive monthly penicillin prophylaxis during a period of 2 years. Two patients refused to follow medical advice; in one a non-migratory arthr itis recurred 15 months after the first episode of arthritis. Conclusion, Commonly, arthritis secondary to beta HSA infection in the Neth erlands, a prosperous West-European country with State Welfare, is not acco mpanied by carditis, contrary to literature on classical ARE Other factors discriminating it from ARF are the age of onset, the non-migratory characte r of the arthritis, the high frequency of erythema nodosum and multiforme, as well as the presence of transient hepatitis. As arthritis is the hallmar k of this syndrome, post-streptococcal reactive arthritis (PSRA) is the mos t proper name for this disease entity. Whether penicillin profylaxis is nee ded in PSRA, as it is in ARE warrants further prospective investigation.