Poststreptococcal reactive arthritis: what is it and how do we know?

OBJECTIVE: To find out whether poststreptococcal reactive arthritis (PSRA) is a discrete, homogeneous clinical syndrome. METHOD: Literature review from case reports and case series. RESULTS: One hundred and eighty-eight cases were identified. The age distribution was bimodal, with one peak in childhood and one peak in adulthood. Eighty-three percent of streptococcal isolates were group A. The clinical presentation was heterogeneous but appeared different both from that of acute rheumatic fever (ARF) and from that of HLA B27-associated reactive arthritis. Carditis was rare. CONCLUSIONS: The term PSRA encompasses significant heterogeneity. The link between the arthritis and the streptococcal infection is unproven.