成人链球菌感染后反应性关节炎一例

Adult-onset poststreptococcal reactive arthritis:a case report

链球菌感染后反应性关节炎(PSRA)是指部分A组乙型溶血性链球菌(GAS)感染后不符合急性风湿热诊断标准的反应性关节炎,临床少见,在其病程早期因缺乏特征性的症状和体征而易被误诊。该文报道了一例成年男性PSRA患者,以反复右足背及内踝肿痛为主要表现,发病过程疑似痛风,在外院进行降尿酸、止痛治疗,疗效欠佳,追问患者有咽炎病史,完善检查发现其CRP、抗链球菌溶血素“O”等升高,最终诊断PSRA并予长期苄星青霉素抗感染及抗炎、镇痛治疗,治疗后患者的病情好转,后续随访未见复发。该例患者的临床诊治过程提醒,若遇到反复发作的关节炎患者,应考虑PSRA的可能性,并应注意与痛风、反应性关节炎进行鉴别诊治。

Poststreptococcal reactive arthritis(PSRA)refers to reactive arthritis after Group A streptococcal(GAS)infection that does not meet the diagnostic criteria for acute rheumatic fever(ARF).It is rare in clinical practice and prone to misdiagnosis due to the lack of characteristic symptoms and signs in the early stage of PSRA.In this article,an adult male patient with PSRA was reported,showing recurrent swelling and pain on the back of the right foot and the medial malleolus.The onset process of the patient was suspected of gout.He received the treatment of reducing uric acid and relieving pain in a local hospital,which was ineffective.The patient was finally diagnosed with PSRA because of the history of pharyngitis and elevated levels of C-reactive protein and antistreptolysin O(ASO)through detection.He received long-term use of benzathine benzylpenicillin combined with anti-inflammatory and analgesic therapy.Subsequently,the condition was improved and no recurrence occurred during follow-up.The diagnosis and treatment of this case prompt that for patients with recurrent arthritis,the possibility of PSRA should be considered.Extensive attention should be paid to differential diagnosis and treatment between gout and reactive arthritis.