Poststreptococcal reactive arthritis and tonsillitis induced reactive arthritis

摘要

Post-streptococcal reactive arthritis (PSRA) is a temporary arthritis following pharyngeal and/or tonsillar infection with Group A, fi-haemolytic streptococci. We investigated the clinical manifestations of adult patients with reactive arthritis (ReA) induced by tonsillitis. All patients were diagnosed and treated at Juntendo Hospital. Patients were 9 male and 12 female aged from 20 to 55 years old. Episode of recurrent arthritis ranged from 2 weeks to 10 years (median: 24 months). Elevated ASO/ASK was revealed in 13 of 21 patients (62.0%) and Group A Streptococcus was isolated in 12 patients (57.1%). Pseudomonas and other bacteria were identified from resected tonsillar abscess. Asymmetrical oligoarthritis of large joints and enthesitis were demonstrated. Nonspecific abdominal pain and erythema were noted in a few patients. No patient revealed carditis during the course of illness and follow-up period of at least 2 years. Rheumatoid factor was positive in 9.5%. HLA-B39 and BW61(B40) were demonstrated in 33.3 and 46.7% (p<0.005, p<0.01, respectively). Eight patients underwent tonsillectomy. Resected tonsils revealed presence of cryptic abscess. Tonsillectomy was especially effective for patients with recurrent tonsillitis and ReA associated with tonsillar abscess.