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Introduction
  • A reactive arthritis to group A beta-hemolytic Streptococcus pyogenes 
  • Epidemiology
    • typical patient is school-aged child of lower socioeconomic status with history of sore throat in past 2-3 weeks
  • Pathophysiology 
    • Characterized by migratory arthritis that involves multiple large joints
  • Systemic manifestations
    • carditis
    • erythema marginatum (painless macules usually on abdomen, but never on the face)
    • subcutaneous nodules (on upper extremity extensor surfaces)
    • chorea
  • Diagnosis based on Jones criteria
    • preceding strep infection with 2 major criteria or 1 major criteria and 2 minor criteria
      • major criteria
        • carditis
        • polyarthralgia
        • chorea
        • erythema marginatum
        • subcutaneous nodules
      • minor criteria
        • fever
        • arthralgia
        • prior rhematic fever
        • increased ESR
        • prolonged PR interval
Presentation
  • Symptoms
    • extremely painful joints; usually knees and ankles
  • Physical exam
    • red and tender joints with effusions
Imaging
  • Radiographs
Labs
  • Antistreptolysin O titers elevated in 80%
  • Synovial Fluid Analysis
Condition WBC (cells/mL) PMNs (%)
Normal <200 <25%
Effusion from trauma <5,000 <25%
Toxic synovitis 5,000-15,000 <25%
Acute rheumatic fever 10,000-15,000

50%

JRA 15,000-80,000 75%
Septic arthritis >50,000 >75%
 
Treatment
  • Nonoperative 
    • penicillin (250,000 U orally BID) and salicylates
 
 

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