Poststreptococcal Reactive Arthritis Research Articles

The role of quantitative sacroiliac scintigraphy in clinical relevance: a literature review

Nuclear skeletal scintigraphy affords a highly sensitive functional method in order to identify systemic skeletoarticular disorders or injuries. Bone scan with quantitative sacroiliac scintigraphy (QSS) is a practical indicator for discovering inflammation/stress of sacroiliac (SI) joints. Sacroiliitis takes place in many situations, for instance, spondyloarthritis, osteitis condendsans ilii, post-streptococcal reactive arthritis, and lower extremity periostitis. QSS exerts a superior tool in scintigraphy rehabilitation and raises alertness for physicians paying more attention to the following steps for exact diagnosis.

O11 Neisseria Meningitidis as a cause of isolated bilateral polyarticular native knee joint septic arthritis

O11 <i>Neisseria Meningitidis</i> as a cause of isolated bilateral polyarticular native knee joint septic arthritis

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

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.

Update on Post-Streptococcal Reactive Arthritis: Narrative Review of a Forgotten Disease.

This topical review attempts to build the concepts of PSRA as an independent entity and discuss prevalent diagnostic criteria. It utilizes a search strategy to collate all clinical features of PSRA reported from across the world and also discusses laboratory and treatment options in brief. There are several immune-mediated diseases described after acute streptococcal infections. Post-streptococcal reactive arthritis (PSRA) is a sterile, self-limiting arthritis that occur as an immune sequelae to streptococcal infection. Though PSRA resembles the arthritis of acute rheumatic fever superficially, it is a separate entity in its own right. It is different from classical reactive arthritis too. It was being recognized worldwide and more frequently in the recent past, possibly due to heightened awareness amongst clinicians. However, research on this enigmatic immune phenomenon is limited. Most acceptable hypotheses suggest molecular mimicry sensitizing the immune system towards synovial peptides such as keratin, vimentin and laminin, leading to arthritis in a genetically predisposed individual. There is still much to be learnt from this unique disease about the vagaries of the immune system.

当科で経験した溶連菌感染後反応性関節炎（PSReA：post-streptococcal reactive arthritis）の1症例

当科で経験した溶連菌感染後反応性関節炎（PSReA：post-streptococcal reactive arthritis）の1症例

EP06 COVID-19 masquerading as myositis and myopericarditis

Case report - IntroductionCoronavirus (SARS-COV-19) typically targets the respiratory tract; however extra-respiratory manifestations such as myositis and myopericarditis may be the only presenting feature.We present a patient with myopericarditis who developed sudden onset muscle weakness. CT thorax showed typical appearance of COVID-19 with an absence of respiratory symptoms. MRI of both thighs revealed diffuse symmetrical myositis. Her clinical and paraclinical abnormalities improved with the aid of steroids. We present our approach to the case and highlight that clinicians should consider myositis as another COVID-19 manifestation when reviewing the differentials. Case report - Case descriptionA 50-year-old female, non-smoker, presented with few days history of central chest pain radiating to her back. This was exacerbated by lying down and inspiration. Associated with mild shortness of breath on exertion. She denied upper respiratory tract symptoms.Her past medical history included hypertension and myopericarditis in 2012 and 2013 requiring pericardiocentesis. In 2017 she presented with post-streptococcal erythema nodosum and reactive arthritis in left ankle.On auscultation her heart sounds were normal, and chest was clear. Initial investigations revealed a mild lymphopenia 0.63, a C-reactive protein of 11mg/L, and a raised troponin 77 and 103 on repeat. D-dimer, Chest x-ray were normal. ECHO showed trivial anterior pericardial effusion, good biventricular function. Treatment included colchicine 500 micrograms four times a day and Ibuprofen 400 mg three times a day.On her second day of admission she developed hypotensive episodes BP 75/49 mm/Hg and mild pyrexia of 37.5 degrees. Her chest pain continued. Electrocardiogram was normal, repeat echocardiogram showed stable 1.40 cm pericardial effusion. CT thorax revealed no dissection or features suggesting pulmonary sarcoidosis but ground-glass opacity changes in keeping with COVID-19. Her COVID-19 swab test came back positive.On the 4th day of admission, she complained of sudden onset of severe pain affecting her thighs, shoulders, and arms, with marked proximal lower limbs and truncal weakness. Because of this, she struggled to mobilise. There was a rapid rise in her creatine kinase from 6.423U/L (day 5) to 32.230 U/L (day 7). ALT increased to 136. MRI showed diffuse myositis with symmetrical appearances involving the anterior, medial, and posterior muscle compartments of both thighs.In view of her previous and current presentation, autoimmune screen and extended myositis immunoblot were sent and were negative. Interestingly, her clinical and paraclinical abnormalities improved dramatically after few days with no steroids initially.Case report - DiscussionThe identification of extra-pulmonary manifestations neurological, cardiac, and muscular have recently increased as the number of COVID-19 cases grow. This case highlights cardiac and skeletal muscle involvement could perhaps represent early or only manifestation of COVID-19.Cardiac involvement in COVID-19 commonly manifests as acute cardiac injury (8–12%), arrhythmia (8.9–16.7%) and myocarditis. In our case the cardiac MRI demonstrated evidence of myocarditis in the basal inferoseptum and apex. Myalgia and muscle weakness are among the symptoms described by patients affected by COVID-19. Some studies report the prevalence of myalgia to be between 11%-50%. The onset of symptoms and the fact that her symptoms improved rapidly led us to consider a viral myositis as the underlying cause, the viral component being COVID-19. We also considered other potential causes. There are reported cases of colchicine myopathy however this is more common in patients with renal impairment, which was absent in this case.On further examination she did not have other clinical signs or symptoms of connective tissue disease or extra muscular manifestation of autoimmune myositis. Her abnormal ALT may be derived from damaged muscle, and therefore in this context is not necessarily a specific indicator of liver disease. Interestingly abnormal liver function tests have been attributed in 16 - 53% of COVID-19 cases. Little is known about the multiple biologic characteristics of COVID-19 and there are no established clinic serological criteria for COVID-19 related myositis nor useful values/cut offs to exclude cardiac involvement in myositis, further research is therefore warranted.In conclusion, clinicians should be aware of the rare manifestation of COVID-19 and consider this in the differentials. Of course, it is important in the first instant to rule out any serious underlying disease or overlap disorder before attributing symptoms to COVID-19. Case report - Key learning points Myositis is a rare manifestation of COVID-19 that clinicians should be aware of.Detailed medical history, examination and investigations identifies the most likely underlying cause.In the right clinical context, COVID-19 – 19 testing should be included in baseline tests of patients presenting with myositis.

Infecções das vias aéreas superiores por Streptococcus pyogenes: fisiopatologia e diagnóstico

Objetivo: Evidenciar a fisiopatologia das infecções por Streptococcus pyogenes no trato respiratório superior, suas respectivas complicações e como é realizado o diagnóstico microbiológico. Metodologia: O presente estudo trata-se de uma revisão integrativa da literatura científica caracterizada pela abordagem qualitativa. Foram consultadas as bases de dados eletrônicas PubMed e ScienceDirect-Elsevier, sendo incluídos os artigos escritos em português, inglês e espanhol compreendidos no recorte temporal de 2015 ao ano de 2020. Foram utilizados como descritores, os termos: Streptococcus pyogenes AND Rheumatic Fever; Streptococcus pyogenes AND Arthritis; Streptococcus pyogenes AND Myocarditis; Streptococcus pyogenes AND Pharyngitis, sendo identificados 2619 artigos: 420 na base PubMed; 2199 na ScienceDirect. Ao final do processo de seleção, 22 artigos foram escolhidos para a síntese do presente estudo. Resultados: Para que ocorra a disseminação do microrganismo é necessária à interação com as células hospedeiras, a depender de características como patogenicidade, virulência, carga infectante e região infectada, a probabilidade de invasão pode aumentar consideravelmente e evoluir para quadros crônicos de febre reumática aguda, artrite reativa pós estreptocócica e doença cardíaca reumática. O padrão ouro para o diagnóstico é a cultura da orofaringe, no entanto, existem limitações. Outras alternativas são os testes sorológicos, como a Antiestreptolisina O (ASLO) e a anti-desoxyribonuclease B (anti-DNase). Conclusão: A depender da resposta imune humoral/celular, as complicações perante uma infecção prévia por S. pyogenes são alarmantes, uma vez que à medida que o contágio evolui, as alterações tornam-se proeminentes e irreversíveis.

Post-Streptococcal Reactive Arthritis.

Post-Streptococcal Reactive Arthritis (PSRA) is defined as inflammatory arthritis of ≥1 joint associated with a recent group A streptococcal infection in a patient who does not fulfill the Jones criteria for the diagnosis of Acute Rheumatic Fever (ARF). In this narrative review, we conducted a systematic search on MEDLINE, EMBASE, Cochrane Library and Google Scholar using the words poststreptococcal reactive arthritis. The search covered the time period between 1982 and 2016. The purpose of this review is to summarize the current state of knowledge of PSRA with respect to the definition, epidemiology, clinical presentation and treatment. We also summarize the key differences between PSRA, reactive arthritis (ReA) and ARF. PSRA has a bimodal age distribution at ages 8-14 and 21-37 years with an almost equal male to female ratio. Clinically, it causes acute asymmetrical non-migratory polyarthritis, however, tenosynovitis and small joint arthritis may occur. This disease entity can be associated with extraarticular manifestations, including erythema nodosum, uveitis and glomerulonephritis. The frequency of HLA-B27 in PSRA does not differ from that of the normal population, which suggests that it is a separate entity from ReA. Involvement of the axial skeleton, including sacroiliitis, is uncommon in PSRA. PSRA tends to occur within 10 days of a group A streptococcal infection, as opposed to the 2 to 3 weeks delay for ARF. PSRA can be associated with prolonged or recurrent arthritis, in contrast to ARF, in which arthritis usually lasts a few days to 3 weeks. Treatment usually involves NSAIDs or corticosteroids. We summarize clinical features that help differentiate PSRA from ARF and ReA. First-line treatment options include NSAIDs and corticosteroids. Most cases resolve spontaneously within a few weeks, but some cases are recurrent or prolonged. There are no published randomized controlled trials of PSRA.

Poststreptococcal Reactive Arthritis: Diagnostic Challenges

Poststreptococcal reactive arthritis (PSRA) is associated with prior group A β-hemolytic streptococcal infection and has a reported annual incidence of 1 to 2 cases per 100,000 persons, approximately twice that of acute rheumatic fever (ARF) in the US. Children who present with reactive arthritis are not uncommon in a busy general pediatric practice in the US, whereas children who present with ARF are very rare. Distinguishing PSRA from ARF can be challenging because the symptoms and signs are similar, but the diseases differ in long-term therapy, follow-up evaluation, and prognosis. We review the diagnostic criteria for PSRA, the pertinent features of the 2015 ARF diagnostic guideline from the American Heart Association, and the major characteristics that differentiate PSRA from ARF.

20. A challenging diagnosis of adult-onset Still’s disease in the setting of raised anti-streptolysin O titres

20. A challenging diagnosis of adult-onset Still’s disease in the setting of raised anti-streptolysin O titres

Acute onset of psoriatic spondyloarthritis as a new manifestation of post-streptococcal reactive arthritis: a case series

Streptococcus is well associated with a myriad of inflammatory diseases. Among others, this bacterium is linked to the triggering of psoriasis and to post-streptococcal reactive arthritis (PSRA), an arthritis which is typically confined to peripheral joints. Three patients who developed acute psoriatic spondyloarthritis (SpA) following a recent streptococcal infection are described in this article. We searched the existing literature for cases of axial involvement in PSRA and reviewed the association between streptococcal infection and psoriasis or psoriatic arthritis )PsA). In all patients, psoriatic SpA occurred within 7-10days of a confirmed streptococcal infection. The main presenting syndrome was inflammatory back pain with evidence of acute axial spondyloarthritis on magnetic resonance imaging. One patient had guttate psoriasis, the second patient developed pustular psoriasis, and the third patient had exacerbation of pustular palmoplantar psoriasis. Two patients required treatment with tumor necrosis factor alpha (TNF-α) blockers. Axial involvement in PSRA is very rare. A potential association of streptococcal infection and development of PsA has been explored in several articles. However, to the best of our knowledge, acute psoriatic SpA as a manifestation of PSRA has yet to be described. Acute psoriatic SpA should be considered in the differential diagnosis of new-onset inflammatory back pain followed by psoriasis in young adults who had a recent throat infection. KEY POINTS: • Our case series describes three cases of acute psoriatic spondyloarthritis that occurred within 7--10 days of a confirmed streptococcal infection and progressed to full blown chronic disease. • Acute psoriatic spondyloarthritis as a manifestation of post streptococcal reactive arthritis should be considered in the differential diagnosis of new onset inflammatory back pain followed by psoriasis in young adults who had a recent throat infection.

Clinical spectrum of post‐streptococcal reactive arthritis (PSRA) revisited: Juvenile versus adult‐onset disease

Dear Editor, The term post-streptococcal reactive arthritis (PSRA) refers to a form of reactive arthritis which is characterized by a streptococcal sore throat, a symptom-free interval of approximately 10 days followed by aseptic inflammation involving one or more joints. In the year 1959, post-streptococcal arthritis without cardiac involvement was first reported.1 The term PSRA was first suggested by Goldsmith and Long in 1982.2 The presentation may be like that of acute septic arthritis with sudden onset of fever and severe joint pain. The joint pain is usually out of proportion to the degree of physical findings. The pattern of joint involvement may be monoarticular or polyarticular, migratory, additive or chronic; arthritis is usually non-destructive and self-limiting, but the symptoms may last for months. The treatment response to aspirin is less dramatic than that with acute rheumatic fever. There may be no clear evidence of a preceding streptococcal infection and the throat culture can be sometimes negative.3 We tried to analyze the clinical profile of these patients (adult vs juvenile onset) in our tertiary level referral hospital during the period from 1998 to 2008. Retrospective case records of 25 cases of PSRA attending various outpatient services (Clinical Immunology and Rheumatology clinic, Early arthritis clinic and Pediatrics Rheumatology Clinic) of Christian Medical College and Hospital, Vellore, India were studied. The diagnosis of PSRA was based on criteria proposed by Ayoub et al in 1997.4 Out of 25 cases, 7 (28%) were female and 18 (72%) were male. Nine patients (36%) had juvenile-onset disease, whereas 16 (64%) had onset after the age of 16 years. The mean duration of disease at presentation was 3.6 ± 2.66 weeks. Ten patients (40%) had polyarticular onset and 15 patients (60%) had onset in large joints of the lower limbs. Concomitant axial joint involvement was seen in 4 patients (16%). Thirteen patients (52%) had fever and leucocytosis. Juvenile-onset patients had fever along with leucocytosis more frequently (78% vs 22%) as compared to those having disease onset after the age of 16 years (P = 0.058).The mean duration of persistent joint pain was longer in the later / adult age group patients as compared to juvenile-onset disease (29.25 ± 18.51 vs 16.78 ± 14.85 weeks; P = 0.049). None had any residual joint damage or deformity. No extra-articular feature such as carditis was seen, a findings similar to that described by Sato et al from Japan.5 As per decription in literature, PSRA is a rare but benign disease with varied clinical manifestations. In our study, we noted that the arthritis tends to persist for longer duration in later /adult onset PSRA as compared to juvenile-onset disease. PSRA should be considered in the differential diagnosis of a young adult with arthritis involving the lower limbs.6 Although substantial controversy still exists regarding the optimal therapy for patients with PSRA, there is concern about the risk of other non-suppurative complications upon recurrence.7 As streptococcal infections in the adult population are increasingly being reported, it is a timely opportunity to revisit PSRA and develop comprehensive treatment and antibiotic prophylaxis guidelines.8 In the adult-onset PSRA, it may be prudent to give antibiotic prophylaxis as the arthritis is prolonged; one such option include use of sulfasalazine as a disease-modifying agent, even though PSRA is classified by some as nonclassical reactive arthrits. None.

A retrospective study: Acute rheumatic fever and post-streptococcal reactive arthritis in Japan

BackgroundAcute rheumatic fever (ARF) and post-streptococcal reactive arthritis (PSRA) are immune-mediated consequences of group A streptococcal pharyngitis. ARF has declined in developed nations. No prevalence survey of PSRA has been conducted. This study evaluated the incidence and characteristics of ARF and PSRA in Japanese children. MethodsFrom 2010 to 2015, ARF and PSRA were evaluated using clinical data retrospectively collected by chart review from 528 hospitals. ResultsFrom 323 hospitals (61% response rate), 44 cases of ARF and 21 cases of PSRA were reported. Patients with ARF and/or PSRA were mainly from large cities in Japan. The mean age of ARF occurrence was 8.5 years, and the ratio of female/male patients was 16:28. Major manifestations in the acute phase included carditis, 27 cases (61.4%); polyarthritis, 22 cases (50%); erythema marginatum, 7 cases (15.9%); Sydenham chorea, 3 cases (6.8%); and subcutaneous nodules, 1 case (2.3%). Twenty-one (58.3%) patients had migratory arthritis. During the follow-up period, 6 patients (13.6%) showed mild carditis. For PRSA, the mean age was 8.2 years, and the ratio of female/male patients was 12:9. Six (28.6%) patients had monoarthritis, and 4 (19%) patients had migratory arthritis. No patient had carditis. ConclusionsAlthough ARF and PSRA are rare in the Japanese pediatric population, substantial numbers of patients with both conditions were identified in this study. We observed a high incidence of arthritis and carditis in ARF patients. No PSRA case was complicated with carditis. General pediatricians need to have updated information about ARF and PSRA, even in industrialized countries.

A Rare Adult Case of Sacroiliitis due to Poststreptococcal Reactive Arthritis

Poststreptococcal reactive arthritis is a type of sterile arthritis which occurs after a betahemolytic streptococcal throat or skin infection. It was defined as scarlatinal arthritis in 1959. Poststreptococcal reactive arthritis is a kind of non-migratory arthritis that usually affects the knee and ankle joints. Although rare, small joints and the axial skeleton may also be involved. In this report, we present a patient with unilateral sacroiliac joint inflammation and adductor enthesopathy following an upper respiratory tract infection who was eventually diagnosed with poststreptococcal reactive arthritis.

Concurrent peritonsillar abscess and poststreptococcal reactive arthritis complicating acute streptococcal tonsillitis in a young healthy adult: a case report

BackgroundStreptococcus pyogenes is responsible for 5-15% and 20-30% of acute pharyngitis/tonsillitis in adults and children, respectively. It not only causes acute illness but also can give rise to local suppurative complications such as peritonsillar abscess as well as trigger the postinfectious syndromes of glomerulonephritis, acute rheumatic fever and poststreptococcal reactive arthritis. Here, we report a case of a young healthy adult in whom both peritonsillar abscess and poststreptococcal reactive arthritis developed as a complication of acute streptococcal tonsillitis. To the best of our knowledge, such a coincidence of poststreptococcal sequelae has not been reported previously.Case presentationA 32-year-old previously healthy woman was diagnosed with acute tonsillitis by her family doctor and treated empirically with amoxicillin/clavulanic acid (875/125 mg) twice daily for 5 days. Four days after completing antibiotic therapy, peritonsillar abscess of left tonsil developed. Needle aspiration followed by incision and drainage were performed by otolaryngologist at the Emergency Department. Next, the patient was discharged home on a 10-day course of cefuroxime and metronidazole. The symptoms of peritonsillar abscess were subsiding during treatment, however on the last day of antibiotic therapy, swelling and pain of the left ankle appeared. Five days later the patient was consulted by rheumatologist. Cultures of throat swabs and abscess aspirate collected 2 weeks before revealed the presence of Streptococcus pyogenes. Antistreptolysin O (ASO) titer was evaluated and proved to be 412 IU/ml (normal 0–200 IU/ml). The level of C-reactive protein was 13,0 mg/L (normal <5,0 mg/L). There was no known cardiac involvement. Poststreptococcal reactive arthritis was diagnosed. Left ankle arthralgia persisted for about 5–6 weeks. Six months after the presentation at the Emergency Department, the patient was well, with ASO titer reaching 262 IU/ml.ConclusionsClinicians should be aware that appropriate choice of antibiotic, proper dose as well as duration of therapy of acute GAS pharyngitis/tonsillitis are crucial to prevent poststreptococcal sequelae.

Artritis postestreptocócica en un paciente adulto: reporte de caso

Post-streptococcal reactive arthritis is an entity that includes joint involvement secondary to oropharyngeal infectious process associated with beta hemolytic group A Streptococcus. We report a clinical case of 43 year-old man, previously healthy, that seven weeks after a tonsillopharyngitis, developed an additive, non-migratory oligoarthritis, with skin lesions. High titers of antistreptolysin O antibodies are documented, with fulfillment of Ayoub and Ahmed proposed criteria for post streptococcal reactive arthritis. The patient presented adequate response to moderate doses of corticosteroids.

A105: Late Cardiac Assessment in Children Who Were Diagnosed With Post Streptococcal Reactive Arthritis—A Long Term Study

Background/Purpose:In different from rheumatic fever (RF), the association of post streptococcal reactive arthritis (PSRA) and carditis is controversial. Currently the American Heart Association recommends anti‐streptococcal prophylaxis for PSRA for one year, repeat echocardiogram and discontinuation of prophylaxis if normal (level 2, C evidence).Aim—To examine whether there is late cardiac involvement in a cohort of children with PSRA.Methods:Children with defined PSRA who were followed at the pediatric rheumatology units in Meir and Kaplan hospitals had echocardiography, done by pediatric cardiologists, at least 1 year following diagnosis.Results:146 PSRA patients fulfilled the study criteria. Of these, 69 had undergone echocardiography 1–6.9 years from diagnosis. All had normal major parameters. 20 patients had minimal findings: 5 (7.2%) mild mitral insufficiency; 12 (17.4%) minimal mitral insufficiency; 2 (2.9%) mild tricuspid insufficiency and one patient (1.4%) had very mild aortic insufficiency. All were consistent as non significant findings. Of the 77 patients who did not complete echocardiography, 31 were randomly excluded from the study, 26 refused to undergo echocardiography, and 20 were lost to followup, all were asymptomatic according to their medical record or telephone questionnaire. There were no statistically significant differences between the group that had completed echocardiography to the group that had not.Conclusion:No late cardiac involvement was found in our pediatric PSRA patients. Therefore, different approaches to antibiotic prophylaxis for PSRA and RF are probably justified. A prospective, double blind placebo controlled study is needed to definitively assess the necessity of prophylaxis in PSRA.

Poststreptococcal Reactive Arthritis and Acute Rheumatic Fever: Similarities, Differences, Clinical Approach and Therapy

Poststreptococcal reactive arthritis (PSRA) and Acute rheumatic fever (ARF) are twocomplications of preceding pharyngeal infections with a group A beta hemolytic streptococcus(GABHS) or Streptococcus pyogenes. Although ARF is much earlier known poststreptococcalcomplication, PSRA is first described in 1982. There is ongoing debate on whether these twoconditions represent distinct clinical entities or are parts at the spectrum of the same disease. Inthis review, we aim to describe both clinical presentations, and to discuss their similarities anddifferences, clinical impacts and importance

PReS-FINAL-2192: Late cardiac assessment in children who were diagnosed with post streptococcal reactive arthritis - a long term study

In different from rheumatic fever (RF), the association of post streptococcal reactive arthritis (PSRA) and carditis is controversial. Currently the American Heart Association recommends anti-streptococcal prophylaxis for PSRA for one year, repeat echocardiogram and discontinuation of prophylaxis if normal (level 2, C evidence).

SP0178 Post streptococcal and beyond

Group A streptococcal infection, occurs frequently, mainly as acute tonsillitis, might lead to a variety of immune manifestations in genetically susceptible hosts. Rheumatogenic M type serotypes lead to Rheumatic fever...