Question
I saw my internist for a case of sudden onset polyarticular arthritis (though mostly arthralgias) that started about 8 days after onset of a febrile illness that included severe pharyngitis. A strep culture was eventually positive and I was treated with 10 days of amoxicillin. ESR and CRP were slightly elevated. My joint pain continued so I was referred to a rheumatologist who diagnosed poststeptococcal reactive arthritis. RF, ESR and CRP were negative at that visit. My joints were progressively if slowly improving when, at 6 1/2 weeks after the onset of the first illness, I again developed a very sore throat and swollen glands. I started a second round of amoxicillin my internist had given me in case I was exposed to strep again (I have two small children in preschool). Within a few days I experienced a definite exacerbation of the arthritis symptoms–not as severe as the first round but definitely worse. The rheumatologist says he thinks I should be better by now if it was PSRA (I’m now 8 weeks past confirmed strep) and suggests it may be early RA. Is there a usual course that poststrep reactive arthritis follows and how is it usually managed? I can’t seem to find a lot of information about the range of experience with this condition.
Answer
Post streptococcal arthritis generally occurs about 2 weeks after a strep infection and resolves by 6 to 12 weeks. The question about your history is whether you truly had a second strep infection in which case your course could be longer.
