Rheumatology Advance Access published online on April 17, 2008
Rheumatology, doi:10.1093/rheumatology/ken122
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Recent-onset childhood arthritis—association with Streptococcus pyogenes in a population-based study
1Department of Rheumatology, Rikshospitalet Medical Centre, 2Department of Paediatrics, Ullevål University Hospital, 3Department of Biostatistics, Rikshospitalet Medical Centre, Oslo, 4Department of Paediatrics, Akershus University Hospital, 5University of Oslo, Akershus Faculty Division, Nordbyhagen, 6Institute of Microbiology, Rikshospitalet Medical Centre and 7University of Oslo, Oslo, Norway.
Correspondence to:
Ø. R. Riise, Department of Rheumatology, Rikshospitalet Medical Centre N-0027, Oslo, Norway. E-mail: oystein.riise{at}rikshospitalet.no
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Abstract |
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Objectives. To assess the frequency of Streptococcus pyogenes in children with early arthritis, compare the characteristics in patients with post-streptococcal ReA (PSReA) with those in patients with other types of arthritis, and describe the occurrence of carditis in PSRA.
Patients. In a population-based Norwegian study, the physicians were asked to refer all children with suspected arthritis. The arthritis patients were followed up at 6 weeks, 6 months and 18 months. The presence of S. pyogenes was based on throat smear or antibodies. Echocardiography was performed in the patients with ARF or PSRA.
Results. Thirty-two (18%) of the 173 children with arthritis tested positive for S. pyogenes. The percentage of positive tests rose steadily with age and peaked at ages 8–11 (35%). Six weeks after admission arthritis was present in 33% of the PSRA patients, which was less frequent than in the juvenile idiopathic arthritis (JIA) patients (P < 0.001), but more frequent than in the transient arthritis patients (P = 0.012). Hip arthritis was more frequent and knee/ankle arthritis, ANA and HLA-B27 were less frequent in PSRA than in JIA (P < 0.001, P = 0.009 and P = 0.029, respectively). The PSRA patients were older than those with transient arthritis (P = 0.007). One child with ARF had carditis.
Conclusions. Streptococcus pyogenes was present in 18% of children with arthritis. The patient characteristics, clinical presentation and early disease course in PSRA was different from that of JIA and transient arthritis.
KEY WORDS: Post-streptococcal reactive arthritis, Streptococcal infection, Reactive arthritis, Child
Submitted 17 December 2007;
revised version accepted 19 February 2008.
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