Brackel Caroline L H, Noordzij Jeroen G
Leids Universitair Medisch Centrum, Willem-Alexander Kinderziekenhuis, Leiden.
Ned Tijdschr Geneeskd. 2015;159:A9083.
Group A streptococcal (GAS) infection can cause septic arthritis (SA), acute rheumatic fever (ARF) and post-streptococcal reactive arthritis (PSRA). Differentiating between these three entities can have important consequences for both therapy and prognosis. SA is diagnosed by means of clinical, biochemical and microbiological parameters. With respect to ARF and PSRA, evidence of a recent GAS infection should be established, in combination with several other major or minor criteria. Currently there is ongoing scientific debate as to whether PSRA and ARF are two different disease entities or belong to the same spectrum. PSRA presents earlier after GAS pharyngitis than ARF, is normally less responsive to NSAIDs, has a longer duration and is often accompanied by skin abnormalities. However, there are also many similarities. In this report we describe three children suffering from GAS-associated arthritis and discuss the symptoms, diagnosis and therapy.
A组链球菌(GAS)感染可导致化脓性关节炎(SA)、急性风湿热(ARF)和链球菌感染后反应性关节炎(PSRA)。区分这三种病症对治疗和预后都可能产生重要影响。SA通过临床、生化和微生物学参数进行诊断。对于ARF和PSRA,应结合其他几个主要或次要标准确定近期GAS感染的证据。目前,关于PSRA和ARF是两种不同的疾病实体还是属于同一谱系存在科学争论。PSRA在GAS咽炎后比ARF出现得更早,通常对非甾体抗炎药反应较差,病程更长,且常伴有皮肤异常。然而,两者也有许多相似之处。在本报告中,我们描述了三名患有GAS相关关节炎的儿童,并讨论了其症状、诊断和治疗。