POST-STREPTOCOCCAL JOINT MANIFESTATIONS: COMPARISON BETWEEN ATYPICAL ARTICULAR MANIFESTATIONS OF RHEUMATIC FEVER AND POST-STREPTOCOCCAL
Abstract
This study seeks to describe the clinical spectrum of post-streptococcal joint manifestations, with emphasis on the complex differentiation between atypical articular manifestations of Rheumatic Fever (RF) and Post-Streptococcal Reactive Arthritis (PSRA). Although both are non-suppurative complications of Group A beta-hemolytic Streptococcus infections, the considerable overlap of symptoms — such as additive arthritis, small joint involvement, and enthesitis — creates diagnostic uncertainty. This diagnostic challenge is clinically relevant because it may delay the detection of subclinical carditis associated with RF and compromise the appropriate definition of antibiotic prophylaxis. To this end, a narrative literature review was conducted using the PubMed, BVS, SciELO, and Google Scholar databases, covering publications from 2014 to 2025. The study is based on the premise that, although soft tissue involvement may be similar, atypical RF and PSRA differ regarding latency period, articular pattern, therapeutic response, and risk of cardiac involvement. The reviewed literature demonstrates that PSRA tends to present a persistent oligoarticular course with slower response to anti-inflammatory drugs, whereas atypical RF remains more strongly associated with carditis, including subclinical forms. Therefore, this study seeks to synthesize the main clinical, laboratory, and echocardiographic criteria useful for differential diagnosis and for defining therapeutic follow-up and prophylactic strategies in these patients.
Author Biographies
Medical Student at UNICEPLAC – Apparecido dos Santos Central Plateau University Center.
Medical Student at UNICEPLAC – Apparecido dos Santos Central Plateau University Center.
Medical Student at UNICEPLAC – Apparecido dos Santos Central Plateau University Center.
Master’s Degree in Science and Health Education. UNICEPLAC – Apparecido dos Santos Central Plateau University Center.
References
ALAM, Md. Saidul et al. Subclinical carditis in acute rheumatic fever: a single center experience. Cardiology and Cardiovascular Medicine, [S. l.], v. 7, n. 4, p. 311–315, 2023. DOI: https://doi.org/10.26502/fccm.92920341 Disponível em: https://www.fortunejournals.com/articles/subclinical-carditis-in-acute-rheumatic-fever-a-single-center-experience.html . Acesso em: 9 ago. 2025.
BHUTIA, Euden et al. Atypical articular presentations in Indian children with rheumatic fever. Heart, Lung and Circulation, [S. l.], v. 27, n. 2, p. 199–204, fev. 2018. DOI: https://doi.org/10.1016/j.hlc.2017.03.159 Disponível em: https://pubmed.ncbi.nlm.nih.gov/28528779/ Acesso em: 9 ago. 2025. DOI: https://doi.org/10.1016/j.hlc.2017.03.159
GEWITZ, Michael H. et al. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation, Dallas, v. 131, n. 20, p. 1806–1818, 19 maio 2015. DOI: https://doi.org/10.1161/CIR.0000000000000205 Disponível em: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000205 Acesso em: 9 ago. 2025.
JAVADI, Vadood et al. Monoarthritis as the initial presentation of acute rheumatic fever in Iran: a single-center retrospective cross-sectional study. Caspian Journal of Internal Medicine, [S. l.], v. 15, n. 2, p. 328–333, 2024. DOI: https://doi.org/10.22088/cjim.15.2.328 Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC11129065/ . Acesso em: 9 ago. 2025.
KALIL, Jorge; GUILHERME, Luiza. Rheumatic fever and post-streptococcal arthritis. In: FIRESTEIN, Gary S. et al. (org.). Firestein & Kelley’s textbook of rheumatology. 11. ed. Philadelphia: Elsevier, 2022. p. 1956–1972. DOI: https://doi.org/10.1016/B978-0-323-31696-5.00115-7
KHAN, Asim; MACMILLAN, Timothy; MORGAN, Jennifer. An old disease re-emerging: acute rheumatic fever. Clinical Medicine, Londres, v. 18, n. 5, p. 400-402, out. 2018. DOI: https://doi.org/10.7861/clinmedicine.18-5-400 Disponível em: https://pubmed.ncbi.nlm.nih.gov/30287435/ Acesso em: 9 ago 2025. DOI: https://doi.org/10.7861/clinmedicine.18-5-400
NANDIKOL, Shreya S. et al. Differentiating post-streptococcal reactive arthritis from acute rheumatic fever: a case report and review of literature. International Journal of Contemporary Pediatrics, [S. l.], v. 12, n. 5, p. 835–838, 2025. DOI: https://doi.org/10.18203/2349-3291.ijcp20251107 Disponível em: https://www.ijpediatrics.com/index.php/ijcp/article/view/6665 Acesso em: 9 ago. 2025. DOI: https://doi.org/10.18203/2349-3291.ijcp20251107
NISHIBUKURO, Maria et al. Poststreptococcal reactive arthritis in Japan. Journal of Infection and Chemotherapy, [S. l.], v. 24, n. 7, p. 531–537, jul. 2018. DOI: https://doi.org/10.1016/j.jiac.2018.02.012 Disponível em:https://pubmed.ncbi.nlm.nih.gov/29606414/ Acesso em: 9 ago. 2025. DOI: https://doi.org/10.1016/j.jiac.2018.02.012
PATHAK, Himanshu; MARSHALL, Tarnya. Post-streptococcal reactive arthritis: where are we now? BMJ Case Reports, London, v. 2016, 12 ago. 2016. DOI: https://doi.org/10.1136/bcr-2016-215552 Disponível em: https://casereports.bmj.com/content/2016/bcr-2016-215552 Acesso em: 9 ago. 2025. DOI: https://doi.org/10.1136/bcr-2016-215552
SATO, Satoshi et al. A retrospective study: acute rheumatic fever and post-streptococcal reactive arthritis in Japan. Allergology International, Tokyo, v. 66, n. 4, p. 617–620, out. 2017. DOI: https://doi.org/10.1016/j.alit.2017.04.001 Disponível em: https://pubmed.ncbi.nlm.nih.gov/28442182/ Acesso em: 9 ago. 2025. DOI: https://doi.org/10.1016/j.alit.2017.04.001
SHANKAR, Binoy; BHUTIA, Euden; KUMAR, Dinesh. Atypical arthritis revisited: acute rheumatic fever. Annals of Pediatric Cardiology, Mumbai, v. 9, n. 2, p. 164–166, maio/ago. 2016. DOI: https://doi.org/10.4103/0974-2069.180670 Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC4867803/ Acesso em: 9 ago. 2025. DOI: https://doi.org/10.4103/0974-2069.180670
SWAMINATHAN, A. et al. Post streptococcal reactive arthritis in children: varied presentations, differentiation from acute rheumatic fever and antibiotic prophylaxis. International Journal of Pediatric Research, [S. l.], v. 4, n. 11, p. 694–697, nov. 2017. DOI: https://doi.org/10.17511/ijpr.2017.i11.10 Disponível em: https://pediatrics.medresearch.in/index.php/ijpr/article/view/335 Acesso em: 9 ago. 2025. DOI: https://doi.org/10.17511/ijpr.2017.i11.10
SZCZYGIELSKA, Izabela et al. Rheumatic fever – new diagnostic criteria. Reumatologia, Warsaw, v. 56, n. 1, p. 37–41, 2018. DOI: https://doi.org/10.5114/reum.2018.74748 Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC5911656/ . Acesso em: 9 ago. 2025. DOI: https://doi.org/10.5114/reum.2018.74748
TANIGUCHI, Yoshinori et al. Expanding the spectrum of reactive arthritis (ReA): classic ReA and infection-related arthritis including poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA. Rheumatology International, Berlin, v. 41, n. 8, p. 1387–1398, ago. 2021. DOI: https://doi.org/10.1007/s00296-021-04879-3 Disponível em: https://link.springer.com/article/10.1007/s00296-021-04879-3 Acesso em: 9 ago. 2025. DOI: https://doi.org/10.1007/s00296-021-04879-3
YAVRUM, Begum Erzurumlu et al. Changing face of acute rheumatic fever in childhood and our clinical results. Northern Clinics of Istanbul, Istanbul, v. 10, n. 2, p. 237–247, 2023. DOI: https://doi.org/10.14744/nci.2021.58966 Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC10170381/ Acesso em: 9 ago. 2025.
License
Copyright (c) 2026 RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218
This work is licensed under a Creative Commons Attribution 4.0 International License.
Os direitos autorais dos artigos/resenhas/TCCs publicados pertecem à revista RECIMA21, e seguem o padrão Creative Commons (CC BY 4.0), permitindo a cópia ou reprodução, desde que cite a fonte e respeite os direitos dos autores e contenham menção aos mesmos nos créditos. Toda e qualquer obra publicada na revista, seu conteúdo é de responsabilidade dos autores, cabendo a RECIMA21 apenas ser o veículo de divulgação, seguindo os padrões nacionais e internacionais de publicação.