- Key biological mechanisms
at issue include organism and host factors that determine patient's
likelihood to develop ARF or PSRA. Examples include repeated episodes
of PSRA, family members with ARF, first few years after PSRA, infection
with certain GAS serotypes.
- Although this is not a
randomized, double-blind, placebo-controlled trial, one could state
that risk of developing carditis after PSRA w/o prophlaxis is 8% in
18 months while risk of carditis after PSRA w/ prophylaxis is 0% in
36 months. The absolute risk reduction would be 8% and NNT would be
12.5 patients, but this is a blatant distortion of the use of this statistic.
- Despite paucity of data,
given the cost and risk-benefit ratio, these studies do affect the management
of the patient. As a result of these studies I would arrange cardiology
follow-up and prophylax my patient.
- Moon RY, Greene MG, et
al. Poststreptococcal reactive arthritis in children: a potential predecessor
of rheumatic heart disease. J Rheumatol 1995; 22: 529-32.
- De Cunto CL, Giannini
EH, et al. Prognosis of children with poststreptococcal reactive arthritis.
Pediatr Infect Dis J 1988; 7: 683-6.