Recent-onset childhood arthritis--association with Streptococcus pyogenes in a population-based study.
OBJECTIVE
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.


METHODS
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.
Riise
Ø R
ØR
Department of Rheumatology, Rikshospitalet Medical Centre N-0027, Oslo, Norway. oystein.riise@rikshospitalet.no
Lee
A
A
Cvancarova
M
M
Handeland
K S
KS
Wathne
K-O
KO
Nakstad
B
B
Gaustad
P
P
Flatø
B
B
D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D001168:Arthritis / Q000175:diagnosis / Q000453:epidemiology; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000453:epidemiology; D016918:Arthritis, Reactive / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009205:Myocarditis / Q000382:microbiology; D009664:Norway / Q000453:epidemiology; D010614:Pharynx / Q000382:microbiology; D000091402:Prohibitins; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*