Background/Purpose:  Acute Rheumatic Fever (ARF) and Post-streptococcal reactive arthritis (PSRA) are well known as post-streptococcal syndromes with arthritis in children. ARF have been declining in developed nations like Japan and it is generally thought to be a disease of the past. Despite decreasing incidence, focal outbreaks have been reported in developed nations. Despite its importance, ARF and PSRA epidemiology has not been reviewed recently. The aims of this study were to assess ARF and PSRA incidence between 2010 and 2015 in Japan.

Methods:  This descriptive epidemiological study examined ARF and PSRA incidence in 2010-2015, using hospitalisation data included in a total of 528 hospitals.

Results:   From a total of 323 hospitals (61% response rate), 44 cases of ARF and 21 cases of PSRA were reported. The mean age of ARF was 8.5 years (3-15 years), and female/male ratio was 16/28. Manifestations including; carditis, 27 (61.3%); arthritis, 36 (81.8%); Erythema marginatum in 7 (16%); Sydenham chorea, 3 (6.8%); Subcutaneous nodules, 1 (2.3%), respectively. And minor criteria were; fever, 39 (88.6%); first degree heart block, 9 (20.5%); elevated inflammatory markers (ESR, CRP), 43 (97.7%). ARF patients were treated with antimicrobial agent therapy.42 (95.5%); NSAIDs 29 (65.9%); and glucocorticoids therapy 24 (54.5%). During the follow up, four patients showed mild carditis and the other were improved. All ARF patients were prescribed with antimicrobial agent prophylaxis. On the other hand, the mean age of PSRA was 8.2 years (2-15 years), and female/male ratio was 12/9. Six (28.6%) patients had monoarthritis. And fever in 14 (66.7%) and Elevated inflammatory markers in 19 (90.5%). PSRA patients were treated with antimicrobial agent therapy.17 (81%); NSAIDs 16 (76.2%); and glucocorticoids therapy 1 (4.8%). During the follow up, there was no patient with carditis. Eleven (52.4%) patients with PSRA were prescribed with antimicrobial agent prophylaxis.

Conclusion:  In this study, ARF is rare in the Japanese pediatric population, but ARF has not yet disappeared. We observed high incidence of arthritis, carditis and erythema marginatum. General pediatrician need to have updated information about ARF and PSRA even in industrialized countries.

Table

Acute Rheumatic Fever (ARF) and Post-streptococcal reactive arthritis (PSRA) cases

From January 1st, 2010 to December 31th, 2015

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-descriptive-epidemiology-of-acute-rheumatic-fever-and-post-streptococcal-reactive-arthritis-in-japan/