Acute rheumatic fever and poststreptococcal reactive arthritis: Diagnosticand treatment practices of pediatric subspecialists in Canada

Objective. We conducted a survey of pediatric specialists in rheumatology, cardiology, and infectious diseases to ascertain present Canadian clinical practice with respect to diagnosis and treatment of acute rheumatic fever ( ARF) and poststreptococcal reactive arthritis (PSReA), and to determine wha t variables influence the decision for or against prophylaxis in these case s. Methods. A questionnaire comprising 6 clinical case scenarios of acute arth ritis occurring after recent streptococcal pharyngitis was sent to members of the Canadian Pediatric Rheumatology Association, and to heads of divisio ns of pediatric cardiology and pediatric infectious diseases at the 16 univ ersity affiliated centers across Canada, Results. There is considerable variability with respect to diagnosis in cas es of ReA following group A streptococcal (GAS) infection both within and a cross specialties. There is extensive variability regarding the decision to provide prophylaxis in cases designated as ARF or PSReA. Findings indicate d that physicians are most comfortable prescribing antibiotic prophylaxis i n the presence of clear cardiac risk and are less inclined to such interven tion for patients diagnosed with PSReA. When prophylaxis was recommended fo r cases of PSReA, the majority of respondents prescribed longer term course s of antibiotics. Conclusion, The lack of observed consistency in diagnosis and treatment in cases of reactive arthritis post-GAS infection likely reflects the lack of universally accepted criteria for diagnosis of PSReA and insufficient longt erm data regarding carditis risk within this population. There is a need fo r dear definitions and treatment guidelines to allow greater consistency in clinical practice across pediatric specialties.