Should PRSA be treated like a reactive arthritis or in the continuum of ARF?
While some literature suggests PSRA as an entirely distinct clinical entity, with diagnostic criteria based on arthritis after GAS infection without other Jones criteria, others have argued that PSRA is simply an incomplete phenotype of ARF. The incidences of joint and cardiac involvement have an inverse relationship in ARF, while host factors for PRSA (D8/17 and certain HLA DR alleles) are similar to ARF, whereas HLA B-27 does NOT associate with PSRA. The AHA currently recommends 1 year of secondary carditis prophylaxis and monitoring after an episode of PRSA, although studies in children and adults have conflicting data regarding carditis risk following PRSA in the absence of complete ARF criteria. Any episode of arthritis that fulfills revised Jones criteria should be treated as ARF. Furthermore, although PSRA is not associated with HLA-B27, a predominantly lower extremity arthritis following a documented GAS infection has been described in HLA-B27-positive individuals.
