Rheumatic arthritis and psra

Differentiating two closely named different entity.

1. Rheumatic arthritis and PSRA Speaker: Dr. Arnab Nandy 1 st year PGT Dept. of Paediatrics, NBMC&H Moderator: Dr. (Prof) Rakesh Kumar Mondal Dept. of Paediatrics , NBMC&H

2. Introduction Rheumatic fever - ‘licks the joint and bites the heart’ ARF & PSRA – Part of single clinical spectrum Or Different clinical entity Epidemiology- 1. Developing countries 2. Low-socioeconomic strata 3. Over-crowding 4. Winter-spring season 5. 5-15 years of age

3. Pathogenesis Molecular mimicry - GABHS Genetic predisposition – DR4 & DR7 allele Clinical Spectrum Prodrome: Fever, Sore throat, Arthralgia, Malaise Manifestation: Pan- carditis (50-70%) – young age group Poly-arthritis (35-66%) Chorea (10-30%) – latency of 6months Rheumatic nodules (0-10%) – latency of 6weeks Erythema marginatum (<6%)

4. Pathology Exudative phase Proliferative or granulomatous phase Non-communicable but high recurrence rate Diagnosis Revised Jones criteria 2015 – AHA (T Duckett Jones 1944) 5 major criteria 4 minor criteria Evidence of recent strep. infection

5. Rheumatic arthritis in ARF: Immunologic Poly-arthritis( >1 joints) Migratory and fleeting Major large joints Swollen , warm and tender Short duration (avg. – 2weeks) Excellent response to salicylates No residual defect ( Exception – Jaccoud arthritis) Post-streptococcal Rheumatic Arthritis: Arthritis - ≥1 joints Reactive or immunologic Recent group A streptococcal infection Condition not fulfill - the Jones criteria - ARF

6. Similarity and dis-similarity between rheumatic arthritis in ARF and PSRA: Preceding gr A beta hemolytic streptococcal infection Reactive or immunologic pathogenesis Non-erosive or non deforming Differential diagnosis of rheumatic arthritis : SLE Serum sickness Rheumatoid arthritis Post infective reactive arthritis(shigella, salmonella, Yersinia) Sickle cell disease

7. Rheumatic arthritis in ARF PSRA Age predilection Young Adult Time of onset <2-3weeks <10days Joint involvement Poly-articular Large joints>>>small joints More symmetrical Poly or Mono- articular Large joints>Small joints Less symmetrical Migratory nature of arthritis Classical Non migratory and additive Duration and relapse 2-3weeks Prolonged and recurrent Response to salicylate Excellent Partial Laboratory finding ESR – high CRP - high ESR – low CRP - low Similarity and dis-similarity between rheumatic arthritis in ARF and PSRA:

8. Rheumatic arthritis in ARF PSRA Genetics HLA DRB1*16 HLA DRB1*01 Carditis Common Uncommon and late Cont. Variables to look for: ESR CRP Duration of symptoms after starting salicylate Relapse after discontinuation of therapy

9. Implication Antibiotic prophylaxis ARF – Long term prophylaxis PSRA - For 1 year if echocardiogram is normal (no carditis )

10. THANK YOU