Poststreptococcal Reactive Arthritis and the Association With Tendonitis, Tenosynovitis, and Enthesitis

Sarakbi, Housam; Hammoudeh, Mohammed; Kanjar, Izzat; Al‐Emadi, Samar; Mahdy, Salah; Siam, A. R. M.

doi:10.1097/rhu.0b013e3181c3444c

Cited by 20 publications

(7 citation statements)

References 19 publications

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“…Owing to the risk of carditis following a possible relapse, it is preferable to contniue penicillin prophylaxis for 5 years as per WHO guidelines. Polytendinitis, tenosynovitis and enthesitis have been documented in PSRA and so were not contradictory to the initial consideration [9]. However, on follow up, owing to a chronic lingering course and enthesitis in this adolescent boy with subsequent HLA B27 positivity and sacro-ilitis, revision of diagnosis to enthesitis related arthritis was made and child treated for the same currently.…”

Section: Discussionmentioning

confidence: 77%

Post streptococcal reactive arthritis in children: varied presentations, differentiationfrom acute rheumatic fever and antibiotic prophylaxis

Swaminathan¹,

Najih²,

Sagayaraj³

et al. 2017

Int J Pediatr Res

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Post streptococcal reactive arthritis (PSRA) refers to inflammation of one or more joints soon after streptococcal throat infection without a demonstrable presence of the organisms in the joint. We present here, two children with very different forms of PSRA. While the first child had axial and appendicular joint involvement in non-migratory pattern that persisted for a long time with intermittent exacer bation without carditis and with no preceding clinically apparent throat infection,the second child presented with throat infections followed by involvement of knee joints alone in episodic and migratory patterns with disease free intervals in between, but with evidence of mild carditis. Clinical suspicion and close attention to the differentiating features from acute rheumatic fever (ARF) are necessary to arrive at the appropriate diagnosis which could at times be challenging. The need for long term follow up is emphasized as the former child was noted to evolve into enthesitis related arthritis. Presented is a review of differentiating features between ARF and PSRA and the role of antibiotic prophylaxis.

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Section: Discussionmentioning

confidence: 77%

Post streptococcal reactive arthritis in children: varied presentations, differentiationfrom acute rheumatic fever and antibiotic prophylaxis

Swaminathan¹,

Najih²,

Sagayaraj³

et al. 2017

Int J Pediatr Res

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“…Arthralgia presentation in ARF typically occurs around three weeks from pharyngitis and has a duration of two to three weeks. In PSRA the arthralgia presents earlier, typically around 10 days, and can last up to two months after pharyngitis [8]. Patients with PSRA typically have associated or isolated polytendonitis, tenosynovitis, or enthesitis.…”

Section: Discussionmentioning

confidence: 99%

Acute Rheumatic Fever Presenting as a Mimicker of Septic Arthritis

Achebe

Hussain

Abraham

et al. 2020

Cureus

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Acute rheumatic fever (ARF) describes the non-suppurative and autoimmune inflammation of joint, muscle, and fibrous tissue that occurs after group A streptococcal (GAS) pharyngitis. This report describes a rare case of a 39-year-old male with migratory arthralgias as a presenting sign of ARF. Through this case, we review the current literature on ARF and highlight clinical and objective findings that differentiate ARF from similar presenting arthralgias, specifically post-streptococcal reactive arthritis (PSRA). With this report, we hope to increase clinical suspicion for ARF in patients with acute joint pain, as differentiating ARF from other arthritides, PSRA specifically, determines management strategy and need for secondary prophylaxis against rheumatic heart disease.

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“…64 The importance of concomitant use of CT in the assessment of SI joints along with scintigraphy includes the following: the combination of semi-quantitative analysis of CT and quantitative analysis of SI joints can increase the unique specification of the risk level for active sacroiliitis; 65 CT is the gold standard for bone erosion and superior to conventional radiography and MRI, 65 it enables the crosssectional, multi-planar visualisation of the pathologic processes, which was better than conventional radiography, [66][67][68] in addition, the Modified New York Criteria scoring system for sacroiliitis can also applied to CT; by using spectral CT, fat deposition and bone marrow oedema can be measured similarly to MRI, which can increase the sensitivity for early changes of sacroiliitis; 65,68 and, other than bony erosion and relative water and calcium ratio of the SI joint, CT can detect sclerosis and syndesmophytes, which could be helpful to identify differential diagnoses in chronic changes in sacroiliitis. 65,68 Quantitative Sacroiliac Scintigraphy for Post-Streptococcal Reactive Arthritis Titers of anti-streptolysin O (ASLO) are of diagnostic value in the early detection of poststreptococcal reactive arthritis (PSRA), 48,[69][70][71] early arthritis after rheumatic fever, [72][73][74] and movement disorder. 75 The dividing line is normal if the titer is ≤116 IU/mL, and abnormal if the titer is >116 IU/mL.…”

Section: Quantitative Sacroiliac Scintigraphy For Spondyloarthropathy Including Ankylosing Spondylitismentioning

confidence: 99%

A Worthwhile Measurement of Early Vigilance and Therapeutic Monitor in Axial Spondyloarthritis: A Literature Review of Quantitative Sacroiliac Scintigraphy

et al. 2021

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Background: Back pain a common cause for hospital visits. Nuclear skeletal scintigraphy, at a high sensitivity, provides a functional imaging for detecting bone diseases. Sacroiliitis is an inflammation of the sacroiliac joint. Bone scan with quantitative sacroiliac scintigraphy (QSS) has been a useful inflammation indicator for sacroiliac joints. However, QSS has been ignored in the rehabilitation practice. Objective: To present the background, mechanisms, and current clinical applications of bone scan with QSS in spondyloarthropathy (SpA). Methods: The authors performed a literature review of QSS through database searching of MEDLINE, Embase, CINAHL, HaPI, Cochrane Review, and citation mining. Studies were included if they had QSS in the methodology performed in adult patients with various diseases. Any articles, including the authors’, that can be performed in a clinical setting were enrolled. Articles explicitly referencing QSS were retained for screening. Results: QSS appearance of SpA, including ankylosing spondylitis, may give rise to early detection. The specificity of sacroiliitis based on QSS increases from 73% to 97%. After investigating the relationship between serum C-reactive protein and sacroiliac joint inflammation in patients with SpA, there appeared to be a significant difference between serum C-reactive protein in serum and in sacroiliac ratio (particularly the middle part of the both joints), indicating a systemic inflammatory response to flair-up of SpA, for example, serum C-reactive protein as an indicator of inflammation. Sacroiliitis also occurs in post-streptococcal reactive arthritis. The involvement of sacroiliac joints in the development of post-streptococcal reactive arthritis had been demonstrated a significant correlation between anti-streptolysin O titres and QSS in patients with post-streptococcal reactive arthritis. Lower extremity periostitis acts as a human model in the study of bottom-up processing for periostitis-induced sacroiliac pain. The use of QSS can also monitor sacroiliac joint dysfunction before and after laser therapy. Improvements of the sacroiliac joint after convalescing of foot periostitis have been reported. Conclusions: Bone scan using QSS is a good screening measurement in scintigraphy rehabilitation for early detection of SpA and raises awareness of physicians toward the next step of diagnosis.

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Poststreptococcal Reactive Arthritis and the Association With Tendonitis, Tenosynovitis, and Enthesitis

Abstract: It is concluded that polytendonitis, tenosynovitis, and enthesitis are common presentations in PSRA and could be the only manifestation of poststreptococcal infection.

Cited by 20 publications

References 19 publications

Post streptococcal reactive arthritis in children: varied presentations, differentiationfrom acute rheumatic fever and antibiotic prophylaxis

Post streptococcal reactive arthritis in children: varied presentations, differentiationfrom acute rheumatic fever and antibiotic prophylaxis

Acute Rheumatic Fever Presenting as a Mimicker of Septic Arthritis

A Worthwhile Measurement of Early Vigilance and Therapeutic Monitor in Axial Spondyloarthritis: A Literature Review of Quantitative Sacroiliac Scintigraphy

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