DIFFERENTIATING ACUTE RHEUMATIC FEVER AND POST-STREPTOCOCCAL REACTIVE ARTHRITIS

Selections from Journal Watch Pediatrics and Adolescent Medicine

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ARF is more acute than is PSRA.

Both acute rheumatic fever (ARF) and post-streptococcal reactive arthritis (PSRA) occur after streptococcal throat infections and are associated with symptoms of arthritis, but only ARF requires antibiotic prophylaxis to prevent recurrence. To examine clinical differences between ARF and PSRA and discern whether they are two distinct diseases or variants on an ARF spectrum, investigators retrospectively reviewed the medical charts of 68 children with ARF and 159 with PSRA (age, <16 years) from an Israeli rheumatology registry.

Patients with ARF had significantly higher erythrocyte sedimentation rates (ESR; mean, 92 vs. 57 mm/h) and C-reactive protein (CRP) levels (mean, 107 vs. 25 mg/L), significantly shorter durations of joint symptoms after starting anti-inflammatory therapy (mean, 2 vs. 7 days), and significantly lower rates of relapsing joint symptoms after discontinuation of therapy (7% vs. 21%).

COMMENT

The differences in acute-phase reactants, relapse rates, and response of joint pain to anti-inflammatory regimens suggest, but do not prove, that ARF and PSRA are more likely to be different diseases resulting from group A streptococcal infection than to be variants of the same syndrome. ESR and CRP level at symptom onset might help inform discussions with a child’s family about the potential diagnoses and the likely disease course after the child starts anti-inflammatory therapy.

— Peggy Sue Weintrub, MD

Published in Journal Watch Pediatrics and Adolescent Medicine December 24, 2008

▸ Barash J, . Differentiation of post-streptococcal reactive arthritis from acute rheumatic fever. J Pediatr 2008 Nov;153:696.

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