Reactive poststreptococcal arthritis

Background

• Arthritis of one or more joints after Group A strep pharyngitis
  • May represent mild form of rheumatic fever or separate entity
• Not associated with other Major Jones criteria; milder illness than rheumatic fever

Clinical Features

• Begins approximately 10d after strep infection (compared to 21d for rheumatic fever)
• Arthritis
  • Generally more severe than that in RF
  • Non-migratory, mono or oligoarthritis
  • ASA-resistant
• Erythema nodosum and erythema multiforme are frequently seen

Differential Diagnosis

Monoarticular arthritis

Algorithm for Monoarticular arthralgia

• Acute osteoarthritis
• Avascular necrosis
• Crystal-induced (Gout, Pseudogout)
• Gonococcal arthritis, arthritis-dermatitis syndrome
• Nongonococcal septic arthritis
• Lyme disease
• Malignancy (metastases, osteochondroma, osteoid osteoma)
• Reactive poststreptococcal arthritis
• Trauma-induced arthritis
  • Fracture
  • Ligamentous injury
  • Overuse
• Avascular necrosis
• Decompression sickness
• Spontaneous osteonecrosis
• Hemorrhagic (e.g. hemophilia, systemic anticoagulation
• Seronegative spondyloarthropathies (ankylosing spondylitis, IBD, psoriatic arthritis, reactive arthritis
• RA, SLE
• Sarcoidosis, amyloidosis
• Periarticular pathology
  • Cellulitis
  • Tendonitis
  • Bursitis
• Transient (Toxic) Synovitis (Hip)
• Slipped Capital Femoral Epiphysis (SCFE)
• Legg Calve Perthes Disease

Polyarthritis

Algorithm for Polyarticular arthralgia

• Fibromyalgia
• Juvenile idiopathic arthritis
• Lyme disease
• Osteoarthritis
• Psoriatic arthritis
• Reactive poststreptococcal arthritis
• Rheumatoid arthritis
• Rheumatic fever
• Serum sickness
• Systemic lupus erythematosus
• Serum sickness–like reactions
• Viral arthritis

Evaluation

• Throat culture

Management

• Penicillin if GAS is recovered from the throat
• NSAIDs

Disposition

• Discharge

See Also

• Arthritis
• Reactive arthritis