Post-streptococcal reactive arthritis (PRSA): An examination of a type of arthritis that can develop following a streptococcal infection

Post-streptococcal reactive arthritis (PRSA) Explained in Brief

In the realm of arthritis, two conditions stand out for their unique characteristics: Post-Streptococcal Reactive Arthritis (PSRA) and Rheumatoid Arthritis (RA). While both can cause joint pain and inflammation, they differ significantly in their causes, timing, symptoms, and treatment.

Cause and Trigger

PSRA is an immune response that occurs approximately 10 days after a streptococcal throat infection. Unlike RA, which is primarily an autoimmune disease, PSRA is post-infectious in nature [1][3][2]. On the other hand, the exact triggers of RA are not clear, but they are believed to involve genetic and environmental factors, not a direct infection.

Timing and Presentation

PSRA typically begins rapidly within about 10 days post-streptococcal infection and tends to be more persistent than acute rheumatic fever arthritis. In contrast, RA usually develops gradually, with symptoms evolving over months to years, though it can sometimes appear suddenly [2][1][3].

Joint Involvement and Pattern

PSRA often affects large joints asymmetrically and may not follow a symmetrical pattern typical of RA [1][3]. RA commonly affects smaller joints symmetrically, especially in the hands and feet, and can lead to joint deformities over time.

Systemic Features

While RA may involve systemic symptoms such as fatigue, low-grade fever, appetite loss, and extra-articular manifestations in the eyes, lungs, heart, and blood vessels, PSRA is generally limited to joint symptoms without prominent systemic autoimmune involvement seen in RA.

Disease Course and Treatment

PSRA may respond well to antibiotics targeting the streptococcal infection and anti-inflammatory drugs, often with resolution over weeks to months. In contrast, RA requires long-term immunomodulatory treatment, including disease-modifying anti-rheumatic drugs (DMARDs), biologics, and physical therapy to slow disease progression and preserve joint function [1][5].

In some cases, if nonsteroidal anti-inflammatory drugs (NSAIDs) do not provide enough symptom relief, doctors may recommend biologic agents for at least 1 year. Assistive devices like a walker or cane may also make it easier for a person to move around.

Complications and Duration

Carditis, a complication of PSRA, can cause inflammation in the heart valves and lead to heart failure. Carditis happens in approximately 20% of cases, but the risk in adults is unclear [4]. PSRA usually lasts about 2 months but can range from 1 week to 8 months.

In conclusion, PSRA is an infection-related reactive arthritis with an acute onset and usually transient course, while RA is a chronic autoimmune arthritis with symmetric joint involvement and systemic manifestations requiring long-term immune-targeted therapy [1][2][3][5]. After antibiotics, a person will get a cardiac evaluation with an echocardiogram, and cold and heat therapies can reduce pain in PSRA. Balance of exercise and rest can help maintain muscle strength and keep joints moving.

[1] Arthritis Foundation. (2021). Post-Streptococcal Reactive Arthritis. Retrieved from https://www.arthritis.org/diseases/psra

[2] Mayo Clinic. (2021). Post-streptococcal reactive arthritis. Retrieved from https://www.mayoclinic.org/diseases-conditions/post-streptococcal-reactive-arthritis/symptoms-causes/syc-20357122

[3] National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2021). Post-Streptococcal Reactive Arthritis. Retrieved from https://www.niams.nih.gov/health-topics/post-streptococcal-reactive-arthritis

[4] National Heart, Lung, and Blood Institute. (2021). Rheumatic Fever and Rheumatic Heart Disease. Retrieved from https://www.nhlbi.nih.gov/health-topics/rheumatic-fever-and-rheumatic-heart-disease

[5] American College of Rheumatology. (2021). Rheumatoid Arthritis. Retrieved from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis

Note: This article is for informational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always consult with a healthcare provider for any health-related questions or concerns.