The Relationship Of Streptococcal Antibody Titers To Clinical Manifestations Of Children With Post-streptococcal Reactive ArthritisL. Nandini Moorthy1, Yanetsi Flores1, Margaret G. E. Peterson2, Karen B. Onel3, Sunanda Gaur1, Maria Baratelli1, Charmi Patel1, Gail Charette1, T. Lehman21Robert Wood Johnson Medical School, New Brunswick, NJ, 2Hospital For Special Surgery, New York, NY, 3La Rabida Children’s Hospital, Chicago, IL, United States
Table: Clinical characteristics over time in children with PSRA
34 children (22 boys) with PSRA of mean age 9.5 ± 3 years had the following ethnicities: Caucasian (n=22), Latino (n=5), Black (n=1), and Asian (n=6). None of the patients fulfilled the Jones criteria. Patients presented with a history of positive throat culture for Group A streptococcus (n=4), PANDAS syndrome (n=1), erythema marginatum (n=1), and subcutaneous nodules (n=1).
Echocardiogram abnormalities were found only in 3 patients who had initial ASLO titres in the range of 700-800: mild mitral regurgitation (n=1), mild mitral valve prolapse (n=1) and mild dilated aortic root, mild aortic insufficiency and mild mitral regurgitation (n=1). All the patients were treated and placed on prophylaxis with penicillin or erythromycin.
At baseline DNAse titres correlated with tender joint count (r=0.4, p=0.03, n=26), ESR (r=0.5, p=0.007, n=25), platelet count (r=0.5, p=0.008, n=25) and WBC (r=0.5, p=0.01, n=25). Similar significant correlations were not seen with ASLO titres. At 8-14 month follow-up, DNAse titres correlated (n=13) with WBC (r=0.4), TJC and SJC (r=0.4) and hemoglobin (r=0.3). The change in DNAse titres from baseline to 8-14 month follow-up period correlated (n=12) with change in arthralgias (r=0.5, p=0.06), ESR (r=0.6, p 0.03), hemoglobin (r=0.5), WBC (r=0.6, p=0.02), platelets (r=0.6, p=0.02), TJC (r=0.5, p=0.1), and SJC (r=0.4, p=0.2).
In children with post streptococcal reactive arthritis (PSRA), the relationship between streptococcal serology and clinical features has not been adequately explored.
Examine the relationship between streptococcal serology and clinical features in children with PSRA over time.
Retrospective chart review of 34 patients seen in the Pediatric Rheumatology Clinic at RWJMS-UMDNJ from January 2004 to July 2005 was conducted and clinical and laboratory data at initial visit and 3-7 months and 8-14 months follow-up were recorded. Data collected included tender joint count (TJC) and swollen joint counts (SJC), antistreptolysin O (ASLO) and deoxyribonuclease B antibody (DNAse) titres, white blood cell count (WBC), and erythrocyte sedimentation rate (ESR). Spearman Rank test was used for correlations.
Over 14 months of follow-up, patients with PSRA improved clinically. DNAse titres may be useful in following patients’ clinical course.