Question
I have had joint/tendon pain since an unresolved strep infection a year and a half ago.I continued to have recurring positive streps for 6 more months. It has almost gone away 3 times, then flares back up. Everytime it flares my strep titers go back up, (dNase at 1380 last time), and I get an erythema marginatum rash. I don’t believe that my throat is infected again as I had my tonsils out 10 months ago, (afterwhich I had immediate improvement). If this pain is from the strep, why doesn’t it go away? Everything I read about PSRA indicates that it is self limiting. If it is not the strep, why do the strep titers go up and the rash come back? I am currently taking 3 gm of sulfasalazine an 200 mg of doxycycline per day.I saw great, if slow, improvement when I began these meds. The pain flared when I went off the doxy for a couple of weeks, 2 months ago. I am still experiencing significant pain in shoulder/arm tendons.
Answer
Generally, by 6 weeks, the post strep symptoms should resolve. While unusual, it is possible that you have reccurent strep infections and recurrent post strep symptoms. Taking antibiotics on a regular basis to prevent strep infections should prevent the joint symptoms if they are due to a post strep process.
