Late cardiac involvement did not occur during a follow-up period of 1-7 years in a small, retrospective study of children who had poststreptococcal reactive arthritis, challenging current advice recommending prophylaxis.
Although current American Heart Association guidelines recommend administering 1 year of antistreptococcal prophylaxis after incidence of poststreptococcal reactive arthritis (PSRA), to be discontinued only if an echocardiogram is normal, lead study investigator Dr. Yosef Uziel of Meir Hospital in Kfar-Saba, Israel, stated that because he and his colleagues found no occurrence of late cardiac involvement in patients at 1 year after an episode of PSRA, "different approaches to antibiotic prophylaxis for PRSA and rheumatoid arthritis are probably justified."
Dr. Uziel and his colleagues reviewed records of 146 patients from two Israeli children’s hospitals, aged 5-15 years (mean of 9 years), who had been diagnosed with PSRA. All patients had received follow-up treatment in the respective hospitals’ rheumatology units for at least 1 year post-PSRA diagnosis. In all, 69 children had received echocardiography from a pediatric cardiologist between 1 and 7 years after being diagnosed with PSRA. Dr. Uziel and his team found that the cardiac indications of all these children were within normal major parameters.
Minimal findings in 20 children included 5 (7.2%) with mild mitral insufficiency; 12 (17.4%) with minimal mitral insufficiency; 2 (2.9%) with mild tricuspid insufficiency; and 1 (1.4%) with very mild aortic insufficiency.
Of the 77 patients who did not complete echocardiography, 31 were randomly excluded from the study, 26 refused echocardiography, and 20 were lost to follow-up. However, Dr. Uziel reported that "all were asymptomatic according to their medical record or telephone questionnaire" and that there were no significant differences between the group that underwent echocardiography and the one that did not.
"A prospective, double-blind, placebo-controlled study is needed to definitively assess the necessity of prophylaxis in PSRA," said Dr. Uziel, who had no financial disclosures to report.