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
References
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