Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan.
Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan.
Allergol Int. 2017 Oct;66(4):617-620. doi: 10.1016/j.alit.2017.04.001. Epub 2017 Apr 22.
Acute 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.
From 2010 to 2015, ARF and PSRA were evaluated using clinical data retrospectively collected by chart review from 528 hospitals.
From 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.
Although 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.
急性风湿热（ARF）和链球菌后反应性关节炎（PSRA）是 A 组链球菌咽峡炎引起的免疫介导性疾病。在发达国家，ARF 的发病率已经下降。目前尚未对 PSRA 的流行情况进行调查。本研究评估了日本儿童 ARF 和 PSRA 的发病率和特征。
2010 年至 2015 年，通过对 528 家医院的病历进行回顾性分析，评估 ARF 和 PSRA 的发病情况。
从 323 家医院（61%的应答率）中报告了 44 例 ARF 和 21 例 PSRA。患有 ARF 和/或 PSRA 的患者主要来自日本的大城市。ARF 发病的平均年龄为 8.5 岁，男女患者比例为 16:28。急性期的主要表现包括心肌炎 27 例（61.4%）、多发性关节炎 22 例（50%）、环形红斑 7 例（15.9%）、舞蹈病 3 例（6.8%）和皮下结节 1 例（2.3%）。21 例（58.3%）患者出现游走性关节炎。在随访期间，6 例（13.6%）患者出现轻度心肌炎。对于 PSRA，平均年龄为 8.2 岁，男女患者比例为 12:9。6 例（28.6%）患者为单关节炎，4 例（19%）患者为游走性关节炎。无患者出现心肌炎。
尽管 ARF 和 PSRA 在日本儿科人群中较为罕见，但本研究仍发现了大量此类患者。我们观察到 ARF 患者关节炎和心肌炎的发病率较高。无 PSRA 病例合并心肌炎。即使在工业化国家，儿科医生也需要掌握 ARF 和 PSRA 的最新信息。
