Moon R Y, Greene M G, Rehe G T, Katona I M
Department of Pediatrics, University of the Health Sciences, Bethesda, MD 20814-4799, USA.
J Rheumatol. 1995 Mar;22(3):529-32.
To report several cases of arthritis seen in children after infection with Group A beta-hemolytic Streptococcus (GABHS) which were not associated with carditis or other major manifestations of the Jones Criteria for acute rheumatic fever (ARF); and to analyze the literature to determine these patients' potential risks for the subsequent development of rheumatic heart disease.
A retrospective chart review was performed of all patients seen in a pediatric rheumatology clinic from January, 1990 to December, 1992.
Four patients were identified with poststreptococcal reactive arthritis (PSReA) and no carditis. Their arthritis had an acute onset, tended to have a longer duration than the arthritis typically seen in ARF, and in most instances did not respond promptly to therapy with aspirin or nonsteroidal antiinflammatory agents. In some patients, there was no history of sore throat or fever. Diagnosis of PSReA was made by serologic testing. Cardiac evaluation in all 4 patients was negative.
PSReA should be considered in the differential diagnosis for any pediatric patient with the acute onset of arthritis, whether the arthritis is the classic migratory polyarthritis typically seen in ARF or not. Throat culture and serologic testing for streptococcal infection should be performed on these patients. If recent GABHS infection is confirmed, cardiac evaluation, including echocardiogram, is warranted. Both ARF and PSReA occur after GABHS infection, but the precise relationship between these 2 entities is unclear. Longterm follow up of pediatric patients with PSReA in previous reports have shown that a certain percentage of them upon subsequent GABHS infection develop carditis. Until the specific risk factors (either host or bacterial characteristics) for developing subsequent carditis are better delineated, antibiotic prophylaxis similar to that used in ARF should be considered in patients with PSReA.
报告数例A组β溶血性链球菌（GABHS）感染后儿童发生的关节炎病例，这些病例与心脏炎或急性风湿热（ARF）的琼斯标准中的其他主要表现无关；并分析文献以确定这些患者后续发生风湿性心脏病的潜在风险。
对1990年1月至1992年12月在儿科风湿病诊所就诊的所有患者进行回顾性病历审查。
确定4例患者患有链球菌感染后反应性关节炎（PSReA）且无心脏炎。他们的关节炎起病急，病程往往比ARF中典型的关节炎更长，并且在大多数情况下，对阿司匹林或非甾体类抗炎药治疗反应不迅速。在一些患者中，没有咽痛或发热史。PSReA的诊断通过血清学检测做出。所有4例患者的心脏评估均为阴性。
对于任何急性起病关节炎的儿科患者，无论关节炎是否为ARF中典型的游走性多关节炎，在鉴别诊断时都应考虑PSReA。应对这些患者进行咽喉培养和链球菌感染的血清学检测。如果近期GABHS感染得到证实，则有必要进行包括超声心动图在内的心脏评估。ARF和PSReA均发生在GABHS感染后，但这两种疾病的确切关系尚不清楚。既往报告中对PSReA儿科患者的长期随访表明，其中一定比例的患者在随后的GABHS感染后会发生心脏炎。在更好地明确后续发生心脏炎的具体危险因素（宿主或细菌特征）之前，对于PSReA患者应考虑采用与ARF相同的抗生素预防措施。
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