Management of Post-Streptococcal Arthritis

Initial Pharmacologic Management

• NSAIDs should be used at the minimum effective dose for the shortest time possible after evaluating gastrointestinal, renal, and cardiovascular risks, as recommended by the European League Against Rheumatism 1, 2
• Systemic glucocorticoids should be used at the lowest effective dose as temporary adjunctive treatment when NSAIDs fail, according to the European League Against Rheumatism 2
• Intra-articular glucocorticoid injections may be considered for localized symptoms, particularly given that PSRA can present with asymmetric oligoarthritis or monoarthritis, as suggested by the American College of Rheumatology 3

DMARDs: Not Indicated

• Disease-modifying antirheumatic drugs (DMARDs) including methotrexate are NOT indicated for PSRA, as this is a self-limited post-infectious reactive arthritis, not a chronic inflammatory arthritis like rheumatoid arthritis, according to the European League Against Rheumatism 4, 5, 6, 7, 8, 9