title: Late cardiac assessment in children diagnosed with post-streptococcal reactive arthritis: a long term study.
abstract: OBJECTIVE
  Unlike rheumatic fever (RF), the association of post-streptococcal reactive arthritis (PSRA) and carditis is controversial. The American Heart Association recommends anti-streptococcal prophylaxis for PSRA for one year, repeating echocardiogram and discontinuation of prophylaxis if normal. In this study the possibility of late cardiac involvement was investigated in a cohort of children with PSRA.
  
  
  METHODS
  Children diagnosed with PSRA and followed at the Paediatric Rheumatology Units at two medical centres in Israel had echocardiography carried out by a paediatric cardiologist, at least 1 year following diagnosis.
  
  
  RESULTS
  146 patients with PSRA met the study criteria. Of these, 69 had undergone echocardiography 1-6.9 years (mean 3.6 years ± 1.5 years) after diagnosis. All had normal major parameters. Twenty (29.0%) patients had minimal cardiac findings, including 5 (7.2%) mild mitral insufficiency, 12 (17.4%) minimal mitral insufficiency, 2 (2.9%) mild tricuspid insufficiency and one patient (1.4%) had very mild, aortic insufficiency. Of the 77 patients who did not have echocardiography, 31 were randomly excluded from the initial study list, 26 refused to undergo echocardiography, and 20 were lost to follow-up. All were asymptomatic according to their medical record or telephone questionnaire. There were no significant differences in clinical or demographic data between those with or without echocardiography.
  
  
  CONCLUSIONS
  No late cardiac involvement was found in our paediatric PSRA patients. Therefore, different approaches to antibiotic prophylaxis for PSRA and ARF are probably suggested. A prospective, controlled study is needed to definitively assess the necessity of prophylaxis in PSRA.
authors.affiliation: Paediatric Rheumatology Unit, Paediatric Cardiology Unit, Paediatric Department, Meir Medical Centre, Kfar Saba, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Perl
authors.affiliation: Paediatric Day Care, Paediatric Rheumatology Unit, Paediatric Cardiology Unit, Department of Paediatrics, Kaplan Medical Centre, Rehovot, affiliated with the Hadassah Medical School, The Hebrew University Jerusalem, Israel.
authors.forename: Ifat
authors.initials: I
authors.lastname: Kvint
authors.affiliation: Paediatric Day Care, Paediatric Rheumatology Unit, Paediatric Cardiology Unit, Department of Paediatrics, Kaplan Medical Centre, Rehovot, affiliated with the Hadassah Medical School, The Hebrew University Jerusalem, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Matitiau
authors.affiliation: Paediatric Rheumatology Unit, Paediatric Cardiology Unit, Paediatric Department, Meir Medical Centre, Kfar Saba, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Levi
authors.affiliation: Paediatric Day Care, Paediatric Rheumatology Unit, Paediatric Cardiology Unit, Department of Paediatrics, Kaplan Medical Centre, Rehovot, affiliated with the Hadassah Medical School, The Hebrew University Jerusalem, Israel.
authors.forename: Judith
authors.initials: J
authors.lastname: Barash
authors.affiliation: Paediatric Rheumatology Unit, Paediatric Cardiology Unit, Paediatric Department, Meir Medical Centre, Kfar Saba, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yosef
authors.initials: Y
authors.lastname: Uziel
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016918:Arthritis, Reactive / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data; D009205:Myocarditis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D063868:Patient Outcome Assessment; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D013290:Streptococcal Infections / Q000150:complications*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents