Post-Streptococcal Arthritis and Oophoritis
Post-streptococcal reactive arthritis (PSRA) does not cause oophoritis. There is no established association between PSRA and ovarian inflammation in the medical literature or clinical guidelines.
What Post-Streptococcal Reactive Arthritis Actually Causes
PSRA is a well-defined inflammatory condition that occurs approximately 10 days after group A streptococcal pharyngitis, presenting with specific musculoskeletal manifestations 1:
Joint and Periarticular Involvement
- Arthritis pattern: Cumulative and persistent arthritis affecting large joints, small joints, or the axial skeleton—distinctly different from the migratory polyarthritis of acute rheumatic fever 1
- Periarticular manifestations: Tendonitis, tenosynovitis, and enthesitis are common and may be the sole manifestation in approximately 19% of cases 2
- Response to treatment: Poor or absent response to aspirin and NSAIDs, unlike acute rheumatic fever which responds rapidly 1
Extra-Articular Manifestations Documented in PSRA
The recognized extra-articular complications of PSRA are limited to 3, 2:
- Vasculitis
- Glomerulonephritis
- Potential cardiac involvement (controversial—see below)
Cardiac Considerations
- Some patients with PSRA have subsequently developed valvular heart disease, requiring careful cardiac monitoring for several months 1
- However, a prospective study in adults showed no long-term cardiac sequelae 1
- The American Heart Association recommends observation for carditis and consideration of secondary prophylaxis for up to 1 year if cardiac involvement develops 1
Why Oophoritis Is Not Part of PSRA
No biological mechanism or clinical evidence links PSRA to ovarian inflammation. The autoimmune response in post-streptococcal conditions targets specific tissues:
- In acute rheumatic fever: cardiac valves, joints, brain (Sydenham chorea), and skin 1
- In PSRA: joints, tendons, and occasionally kidneys and blood vessels 3, 2
- Reproductive organs are not targets of post-streptococcal autoimmune responses
Important Clinical Pitfall
If a patient presents with both arthritis and pelvic/ovarian symptoms, consider alternative diagnoses:
- Pelvic inflammatory disease (PID) can cause both lower abdominal pain and reactive arthritis, but this would be from sexually transmitted pathogens (N. gonorrhoeae, C. trachomatis), not streptococcal infection 1
- The arthritis associated with PID would be classified as sexually acquired reactive arthritis, not PSRA
- PID diagnosis requires uterine/adnexal tenderness or cervical motion tenderness with mucopurulent discharge or WBCs on microscopy 1