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Streptococcal Infections: Differences between Post-Streptococcal Reactive Arthritis and Acute Rheumatic Fever

Tomotaka Shimura, Koichiro Oyake, Sei Kobayashi

Microbial infections have long been empirically known to be associated with arthritic conditions. Among them, Post-Streptococcal Reactive Arthritis (PSReA), a condition occurring following upper respiratory tract inflammation caused by streptococcal infection, has been reported to be different from Acute Rheumatic Fever (ARF), although the differences and distinctions between the two remain unclear. PSReA laboratory findings and symptoms are said to resemble those of ARF but, in case of PSReA, increases in inflammatory response and erythrocyte sedimentation rate in blood tests are often unnoticeable. Whereas ARF is rarely seen in adults and its age of onset is mainly associated with childhood, PSReA has a bimodal peak incidence, in childhood and adulthood, and the onset of arthralgia occurs earlier than in ARF. While arthritis in ARF have been essentially reported to affect only large joints, in PSReA, the pattern of joint involvement, besides large joints, includes also small joints (e.g., fingers). Moreover, one of the main differences between the two diseases is that, while in PSReA arthritis is typically "non-migratory", in ARF, arthritic symptoms are characterized by a "migratory" pattern. Although, unlike ARF, cardiac complications are not known to occur in PSReA, otorhinolaryngologists should take this condition into account when dealing with cases of streptococcal tonsillitis/pharyngitis, which are frequently encountered in routine medical practice.