Poststreptococcal reactive arthritis and the association with tendonitis, tenosynovitis, and enthesitis

Abstract

Aim: To study the clinical presentation of poststreptococcal reactive arthritis (PSRA) and its periarticular manifestation.

Methods: This is a retrospective study. The files of all patients diagnosed with PSRA between January 2004 and November 2007 were reviewed with a predetermined checklist. Patients were included if they met our study criteria for diagnosis of PSRA.

Results: A total of 33 files were reviewed; 26 of these patients (14 female, 12 male, Arab and Asian, aged 11-41 years) met our agreed protocol for the diagnosis of PSRA. The ethnic backgrounds of the patients were as follows: 18 patients were from Arab origins and 8 patients were Asians. Twenty-one patients (80%) had asymmetric complaints, whereas 5 patients (20%) had symmetrical complaints. Two patients (7.6%) had monoarthritis, 8 patients (30.76%) had oligoarthritis, and 11 patients (42.3%) had polyarthritis. Five patients (19.23%) had only polytendonitis, tenosynovitis, and/or enthesitis. Nine patients (34.61%) had tendonitis, tenosynovitis, or enthesitis alone or with arthritis/arthralgia. The average elevation of antistreptolysin antibodies titer was 624.8 and the average sedimentation rate 44 mm/H. The response to nonsteroidal antiinflammatory drugs was generally good (84.6%), being poor in only 4 patients (15.38%) who required treatment with corticosteroids. Prophylactic penicillin was given to 15 patients (57%). No patient had carditis on presentation or follow-up.

Conclusions: It is concluded that polytendonitis, tenosynovitis, and enthesitis are common presentations in PSRA and could be the only manifestation of poststreptococcal infection.