PSRA is a rare complication of streptococcal infections. Symptoms include joint pain, swelling, and stiffness that come on suddenly 7–10 days after infection. Most people recover within weeks to months.

Post-streptococcal reactive arthritis (PSRA) is an uncommon complication of group A streptococcal (GAS) infection. In PSRA, antibodies made during a recent infection cause joint inflammation.

GAS infections like strep throat are very common. But PSRA is rare in the United States, affecting just 1–2 people per 100,000 annually.

For a doctor to diagnose PSRA, you must not meet the criteria for acute rheumatic fever (ARF), a separate and very rare complication of GAS infection.

Keep reading to learn about the symptoms of PSRA, how doctors diagnose and treat it, and when you can expect to recover.

The hallmark symptoms of PSRA are as follows:

Arthritis

The main symptom of PSRA is arthritis (joint pain, swelling, and stiffness) in at least one of your joints. The arthritis comes on suddenly about 7–10 days after GAS infection and lasts an average of 2 months before resolving.

It may not immediately respond to common anti-inflammatory pain medications like ibuprofen.

An older research review looked at English-language, full-text articles identified on PubMed and Medline based on the search terms “streptococcal” and “arthritis.” Researchers reported that about a quarter of people with PSRA developed arthritis in just one joint. In another 37%, two to four joints were affected, and the remainder developed arthritis in five or more joints.

According to a 2021 topical review, smaller, more recent studies have found similar results, though controlled studies are lacking.

In PSRA, arthritis most frequently affects your knee, ankle, wrist, or hip.

Tenosynovitis

Inflammation of the tendon sheaths (tenosynovitis), membranes that wrap around your tendons, occurs in about 35% of people with PSRA. You may also develop nodules along your tendons.

Carditis

Children with PSRA may have a small risk (up to 5.8%) of developing heart inflammation (carditis). This can begin anywhere from 1–18 months after arthritis appears.

Many cases are asymptomatic. Still, some children with carditis may experience:

If your child receives a PSRA diagnosis, they will undergo screening for carditis. In the rare event carditis develops, their doctor will change the diagnosis to ARF.

Available research indicates that adults with PSRA do not develop carditis.

PSRA affects children and young adults with recent GAS infections. Onset peaks at age 8–14 years and again around age 21–37 years.

PSRA affects all genders equally.

Genetics likely play some role in determining risk. People with PSRA are more likely to express a gene called HLA DRB1*01.

Doctors can diagnose PSRA based on your symptoms and laboratory test results. They may also request imaging tests like X-ray, MRI, ultrasound, or CT.

People with PSRA have:

  • sudden onset arthritis in at least one joint that:
  • evidence of recent streptococcal infection (usually by throat swab or blood test)
  • no evidence of ARF

Post-streptococcal arthritis vs. acute rheumatic fever

PSRA and ARF are both rare complications of streptococcal infections. Both can cause arthritis triggered by your immune system. But the arthritis behaves differently:

PSRAARF
Onset7–10 days after infection2–3 weeks after infection
Durationlengthy (weeks to months)short (days to weeks)
Pain moves between jointsnoyes
Number of affected jointsat least onemultiple (five or more)
Response to NSAIDsslowrapid

Importantly, to receive a PSRA diagnosis, you must not meet the diagnostic criteria for ARF.

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If a doctor provides a PSRA diagnosis to you or your child, they’ll prescribe antibiotics to treat the triggering infection and prescribe anti-inflammatory medications to manage your arthritis symptoms.

Although carditis is very rare, experts recommend close monitoring and preventive antibiotics for 1 year after receiving a diagnosis.

Follow-up with your doctor will also continue for at least 1 year to help ensure your symptoms fully resolve without complications.

You can generally expect to make a complete recovery after PSRA.

In PSRA, arthritis lasts an average of 2 months before self-resolving, though there have been reports of symptoms continuing for up to 8 months. There is a risk of arthritis recurring after stopping anti-inflammatory medications. Your doctor can help manage your arthritis symptoms until you recover fully.

In the rare case that carditis develops, your doctor will change the diagnosis to ARF and treat it accordingly.

Other post-streptococcal complications

Most GAS infections undergo successful treatment without complications.

Rarely, GAS infections can cause short-term complications when the infection extends directly into nearby sites in the body, causing abscesses (buildups of pus) or entering the bloodstream.

PSRA is an immune-mediated complication of GAS infection. Your immune system produces antibodies in response to the infection, but those antibodies start to cause problems.

Other immune-mediated post-streptococcal complications include:

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How long does post-streptococcal reactive arthritis last?

Once PSRA affects a particular joint, arthritis symptoms last an average of 2 months. Occasionally, arthritis symptoms may persist for up to several months.

Can I prevent post-streptococcal reactive arthritis?

PSRA is a rare complication of a common infection. Ways to reduce your risk of streptococcal infections include:

  • washing your hands regularly
  • covering your mouth and nose when coughing or sneezing
  • avoiding shared eating and drinking utensils

If you or your child develop symptoms of strep throat or another GAS infection, talk with a doctor about testing and appropriate treatment.

It’s not clear that antibiotics can prevent all immune-mediated post-streptococcal complications. But doctors routinely recommend antibiotics for certain GAS infections as they can reduce the risk of ARF.

Is reactive arthritis the same as rheumatoid arthritis?

No. A previous infection triggers reactive arthritis. PSRA is one example, although typical reactive arthritis is due to gastrointestinal or genitourinary infections. Antibodies formed during the infection mistakenly react with your joints, causing inflammation.

Reactive arthritis is more common in young adult males. Most people with reactive arthritis recover completely.

Rheumatoid arthritis (RA) is a chronic autoimmune disease of unknown cause. RA tends to affect older adults, predominantly females. There is no cure, but you can manage symptoms to prevent long-term joint damage.

What else can cause reactive arthritis?

Many other germs can trigger reactive arthritis, including:

PSRA is a rare complication of GAS infection seen in older children and young adults.

Arthritis affecting one or more joints begins about a week after GAS infection and may not respond quickly to NSAIDs. You may also develop painful tendon nodules and, in rare cases, carditis. Symptoms may last for weeks to months.

A doctor can help distinguish PSRA from other forms of arthritis, such as ARF, which has different treatments and outcomes.

Treatment for PSRA involves antibiotics and anti-inflammatory medications. Your doctor may also monitor you for a year, but you can expect to make a full recovery.