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
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
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
Carditis
Children with PSRA may have a small risk (up to
Many cases are asymptomatic. Still, some children with carditis may experience:
- fatigue
- lightheadedness
- palpitations
- fainting
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.
PSRA affects children and young adults with recent
PSRA affects all genders equally.
Genetics likely play some role in determining risk. People with PSRA are more likely to express a gene called
Doctors can diagnose PSRA based on your symptoms and laboratory test results. They may also request
People with PSRA have:
- sudden onset arthritis in at least one joint that:
- begins within 1–2 weeks after streptococcal infection
- does not stop and start, or move from one joint to the next
- does not respond very quickly to nonsteroidal anti-inflammatory drugs (NSAIDs)
- 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:
| PSRA | ARF | |
|---|---|---|
| Onset | 7–10 days after infection | 2–3 weeks after infection |
| Duration | lengthy (weeks to months) | short (days to weeks) |
| Pain moves between joints | no | yes |
| Number of affected joints | at least one | multiple (five or more) |
| Response to NSAIDs | slow | rapid |
Importantly, to receive a PSRA diagnosis, you must not meet the diagnostic criteria for ARF.
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
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
In the rare case that carditis develops, your doctor will change the diagnosis to ARF and treat it accordingly.
Other post-streptococcal complications
Most
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:
How long does post-streptococcal reactive arthritis last?
Once PSRA affects a particular joint, arthritis symptoms last an average of
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
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
Rheumatoid arthritis (RA) is a chronic autoimmune disease of unknown cause. RA
What else can cause reactive arthritis?
Many other germs can trigger reactive arthritis, including:
- gut infections from bacteria like Salmonella, Campylobacter, and Clostridioides
- genitourinary infections like chlamydia and gonorrhea
- viral infections like rubella, mumps, and hepatitis B
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.