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tendonitis after strep infection


byarsfive
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I am wondering if anyone has had a child who has had acute tendonitis after bouts of strep? My son has had this happen twice now, once last year and now again this week. He had strep prior both times. We saw a specialist at UCLA last year when it happened and her best guess was that it was a response to him having had strep a month prior to the tendonitis. This time, the tendonitis came on a few days after finishing the antibiotics for the strep.

 

I inadvertently posted this on the wrong topic ADHD, so sorry for the multiple post.....

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I am wondering if anyone has had a child who has had acute tendonitis after bouts of strep? My son has had this happen twice now, once last year and now again this week. He had strep prior both times. We saw a specialist at UCLA last year when it happened and her best guess was that it was a response to him having had strep a month prior to the tendonitis. This time, the tendonitis came on a few days after finishing the antibiotics for the strep.

 

I inadvertently posted this on the wrong topic ADHD, so sorry for the multiple post.....

 

This is a very common but sorely under-recognized finding post-strep - in NJ we had an epidemic of acute post-streptocoocal enthesopathy over the past two years. Almost invariably involving bilateral knee and ankle joints with sufficient pain that many of these children refused to walk (and so neurology was called a lot). Everyone went from mild-severe-mild pain over the course of 1-3 days. Although this can possibly be viewed as a minor version of rheumatic fever (no fever, no rash, no heart involvement, just the rheumatic), it's different as that is usually over joints, and this is over tendons.

 

There is almost nothing about this in the literature - so there's another paper to write Sigh.

 

If others can confirm, this might be considered to be another strep warning sign to look out for ....

 

Dr. T

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Hi -

 

Just found this article - very interesting - article (and have to add, that my son (9 years old, PANDASdiagnosed 4 years ago) is having a hurting knee (to the point where he cannot walk), whenever he´s infected with strep, that no doctor so far has ever had an interest in dianosing or treating :-( )

 

JCR: Journal of Clinical Rheumatology:

January 2010 - Volume 16 - Issue 1 - pp 3-6

doi: 10.1097/RHU.0b013e3181c3444c

Original Article

Poststreptococcal Reactive Arthritis and the Association With Tendonitis, Tenosynovitis, and Enthesitis

Sarakbi, Housam Aldeen MD, FACR; Hammoudeh, Mohammed MD, FACP; Kanjar, Izzat MD, FACR; Al-Emadi, Samar MD, FACR; Mahdy, Salah MD; Siam, Abdulrahim MD

 

Abstract

Aim: To study the clinical presentation of poststreptococcal reactive arthritis (PSRA) and its periarticular manifestation.

 

Methods: This is a retrospective study. The files of all patients diagnosed with PSRA between January 2004 and November 2007 were reviewed with a predetermined checklist. Patients were included if they met our study criteria for diagnosis of PSRA.

 

Results: A total of 33 files were reviewed; 26 of these patients (14 female, 12 male, Arab and Asian, aged 11–41 years) met our agreed protocol for the diagnosis of PSRA. The ethnic backgrounds of the patients were as follows: 18 patients were from Arab origins and 8 patients were Asians. Twenty-one patients (80%) had asymmetric complaints, whereas 5 patients (20%) had symmetrical complaints. Two patients (7.6%) had monoarthritis, 8 patients (30.76%) had oligoarthritis, and 11 patients (42.3%) had polyarthritis. Five patients (19.23%) had only polytendonitis, tenosynovitis, and/or enthesitis. Nine patients (34.61%) had tendonitis, tenosynovitis, or enthesitis alone or with arthritis/arthralgia. The average elevation of antistreptolysin antibodies titer was 624.8 and the average sedimentation rate 44 mm/H. The response to nonsteroidal antiinflammatory drugs was generally good (84.6%), being poor in only 4 patients (15.38%) who required treatment with corticosteroids. Prophylactic penicillin was given to 15 patients (57%). No patient had carditis on presentation or follow-up.

 

Conclusions: It is concluded that polytendonitis, tenosynovitis, and enthesitis are common presentations in PSRA and could be the only manifestation of poststreptococcal infection.

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Hi -

 

Just found this article - very interesting - article (and have to add, that my son (9 years old, PANDASdiagnosed 4 years ago) is having a hurting knee (to the point where he cannot walk), whenever he´s infected with strep, that no doctor so far has ever had an interest in dianosing or treating :-( )

 

JCR: Journal of Clinical Rheumatology:

January 2010 - Volume 16 - Issue 1 - pp 3-6

doi: 10.1097/RHU.0b013e3181c3444c

Original Article

Poststreptococcal Reactive Arthritis and the Association With Tendonitis, Tenosynovitis, and Enthesitis

Sarakbi, Housam Aldeen MD, FACR; Hammoudeh, Mohammed MD, FACP; Kanjar, Izzat MD, FACR; Al-Emadi, Samar MD, FACR; Mahdy, Salah MD; Siam, Abdulrahim MD

 

Abstract

Aim: To study the clinical presentation of poststreptococcal reactive arthritis (PSRA) and its periarticular manifestation.

 

Methods: This is a retrospective study. The files of all patients diagnosed with PSRA between January 2004 and November 2007 were reviewed with a predetermined checklist. Patients were included if they met our study criteria for diagnosis of PSRA.

 

Results: A total of 33 files were reviewed; 26 of these patients (14 female, 12 male, Arab and Asian, aged 11–41 years) met our agreed protocol for the diagnosis of PSRA. The ethnic backgrounds of the patients were as follows: 18 patients were from Arab origins and 8 patients were Asians. Twenty-one patients (80%) had asymmetric complaints, whereas 5 patients (20%) had symmetrical complaints. Two patients (7.6%) had monoarthritis, 8 patients (30.76%) had oligoarthritis, and 11 patients (42.3%) had polyarthritis. Five patients (19.23%) had only polytendonitis, tenosynovitis, and/or enthesitis. Nine patients (34.61%) had tendonitis, tenosynovitis, or enthesitis alone or with arthritis/arthralgia. The average elevation of antistreptolysin antibodies titer was 624.8 and the average sedimentation rate 44 mm/H. The response to nonsteroidal antiinflammatory drugs was generally good (84.6%), being poor in only 4 patients (15.38%) who required treatment with corticosteroids. Prophylactic penicillin was given to 15 patients (57%). No patient had carditis on presentation or follow-up.

 

Conclusions: It is concluded that polytendonitis, tenosynovitis, and enthesitis are common presentations in PSRA and could be the only manifestation of poststreptococcal infection.

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I would test for a fungal issue.

Tendonitis could mean excess mycotoxins. Mycotoxins are the waste products from fungi. Antibiotics are fungal and it would make sense that after a course or during a course you might see symptoms like that, especially if the diet is one that feeds fungus and encourages their reproduction and growth.

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Wow - this is interesting. I posted before that our son at the age of 6 had a strange, unexplained infection that dropped his white cell count precipitously (to the point where the family doc was worried about leukemia). Main symptom: he could not walk for several days, and we had to carry him around the house. We were scared to death. After a week or so, his white cell count started rising again and the doc just shook her head, saying she did not know what kind of infection it was but he was apparently fighting it off.

 

Dr. K told us he strongly suspects that kids like our son who are diagnosed with PANDAS after age 10 actually had undiagnosed, milder bouts of it at an earlier age. My wife and I wonder if this "mystery infection" at age 6 was really the start of our son's PANDAS journey....

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Wow - this is interesting. I posted before that our son at the age of 6 had a strange, unexplained infection that dropped his white cell count precipitously (to the point where the family doc was worried about leukemia). Main symptom: he could not walk for several days, and we had to carry him around the house. We were scared to death. After a week or so, his white cell count started rising again and the doc just shook her head, saying she did not know what kind of infection it was but he was apparently fighting it off.

 

Yeah, I think fusarium can do that to the white blood cell count when the fungus is in the blood stream. That usually only happens in immuno-compromised cases. Most doctors know very little about mycotoxins and their effects on human illness. I have been battling fungal problems for thirty years due to prolonged and frequent antibiotics as a child, teen, and young adult.

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You know what, for what it is worth,

here is a good website for newbies to the whole mycotoxin world. I highly recommend all folks giving their kids prolonged and reoccurring doses of antibiotics read about it. Steroid users too. As they are medications made from mold---

http://www.realtimelab.com/mold_information_type.html

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I need to get my medical records! The winter our dd had her first signs of PANDAS (in hindsight), I'd had a super sore throat and shortly after that developed really bad pain in 1 ankle that lasted maybe 4 days. Day 2 I could hardly walk, by day 4 the pain was almost non existent. Dr did c reactive protein/lupus tests etc but nothing showed. It never came back. Reading this thread, I now wonder if it was related.

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I need to get my medical records! The winter our dd had her first signs of PANDAS (in hindsight), I'd had a super sore throat and shortly after that developed really bad pain in 1 ankle that lasted maybe 4 days. Day 2 I could hardly walk, by day 4 the pain was almost non existent. Dr did c reactive protein/lupus tests etc but nothing showed. It never came back. Reading this thread, I now wonder if it was related.

 

 

My son has complained of his fingers and knees hurting during and shortly after a strep infection, this was one of those times that he had strep back to back for 2 months.

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I don't think fungus has anything to do with the symptoms of enthesopathy.

 

Please be careful. Caveat legator, let the reader beware.

 

Fungal infections can profoundly affect the immune system and may be behind some cases of SEVERE immunocompromise.

 

BUT to suggest that we avoid using antibiotics to treat PANDAS due to concerns regarding fungal infection is simply spreading wrong information. There can be mild yeast overgrowth, not the deep seeded fungemia seen in mycotoxic patients.

 

This is not to say that mycotoxins are not an important and perhaps even under-recognized problem in medicine, but this is not what we are talking about here. I'm actually involved in the treatment of two women who have OCD symptoms and are heavily infected with black mold, as well as strep and mycoplasma. But these were women who worked in an extremely infested environment.

 

Dr. T

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I am wondering if anyone has had a child who has had acute tendonitis after bouts of strep? My son has had this happen twice now, once last year and now again this week. He had strep prior both times. We saw a specialist at UCLA last year when it happened and her best guess was that it was a response to him having had strep a month prior to the tendonitis. This time, the tendonitis came on a few days after finishing the antibiotics for the strep.

 

I inadvertently posted this on the wrong topic ADHD, so sorry for the multiple post.....

 

This is a very common but sorely under-recognized finding post-strep - in NJ we had an epidemic of acute post-streptocoocal enthesopathy over the past two years. Almost invariably involving bilateral knee and ankle joints with sufficient pain that many of these children refused to walk (and so neurology was called a lot). Everyone went from mild-severe-mild pain over the course of 1-3 days. Although this can possibly be viewed as a minor version of rheumatic fever (no fever, no rash, no heart involvement, just the rheumatic), it's different as that is usually over joints, and this is over tendons.

 

There is almost nothing about this in the literature - so there's another paper to write Sigh.

 

If others can confirm, this might be considered to be another strep warning sign to look out for ....

 

Dr. T

 

 

When this happened to him last year, it started in one achilles tendon and they booted him. After about 2 weeks in the boot (with no improvement) his other achilles went. That's when they started talking auto immune disorders, and ordering bloodwork. Nothing really showed up except that he had obvious inflammation. Ibuprofen around the clock didn't help either. He was booted on the other leg too, but eventually had to have a wheelchair because he felt pain even in the boots. After about a month total, it went away. Only to reappear right before we went to UCLA in the underside of his elbow (which lasted less than 24 hours) and then the next day in the tendon on his wrist, which also lasted less than a day.

 

The only thing that troubled the UCLA pediatric rheumatologist with her "diagnosis" was that it lasted so long, because she said this type of reactive arthritis usually goes through fairly quickly. Well, here we are a year later, he just spent the last month fighting a sinus infection, strep and staph in the throat, and another sinus infection (4 different antibiotics). He finally feels better (last Tuesday), plays a couple of hours at the park with his buddies, and then his achilles starts bugging him. By the next day he can't walk on it at all, and now even in the boot (from last year) he has pain. Today the 2nd achilles goes down. I am not sure what to do for him. We are going to pediatrician tomorrow, so I guess we'll see what she says.

 

Have you seen this type of tendonitis last so long in a post strep situation?

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I am wondering if anyone has had a child who has had acute tendonitis after bouts of strep? My son has had this happen twice now, once last year and now again this week. He had strep prior both times. We saw a specialist at UCLA last year when it happened and her best guess was that it was a response to him having had strep a month prior to the tendonitis. This time, the tendonitis came on a few days after finishing the antibiotics for the strep.

 

I inadvertently posted this on the wrong topic ADHD, so sorry for the multiple post.....

 

This is a very common but sorely under-recognized finding post-strep - in NJ we had an epidemic of acute post-streptocoocal enthesopathy over the past two years. Almost invariably involving bilateral knee and ankle joints with sufficient pain that many of these children refused to walk (and so neurology was called a lot). Everyone went from mild-severe-mild pain over the course of 1-3 days. Although this can possibly be viewed as a minor version of rheumatic fever (no fever, no rash, no heart involvement, just the rheumatic), it's different as that is usually over joints, and this is over tendons.

 

There is almost nothing about this in the literature - so there's another paper to write Sigh.

 

If others can confirm, this might be considered to be another strep warning sign to look out for ....

 

Dr. T

[/quot

 

When this happened to him last year, it started in one achilles tendon and they booted him. After about 2 weeks in the boot (with no improvement) his other achilles went. That's when they started talking auto immune disorders, and ordering bloodwork. Nothing really showed up except that he had obvious inflammation. Ibuprofen around the clock didn't help either. He was booted on the other leg too, but eventually had to have a wheelchair because he felt pain even in the boots. After about a month total, it went away. Only to reappear right before we went to UCLA in the underside of his elbow (which lasted less than 24 hours) and then the next day in the tendon on his wrist, which also lasted less than a day.

 

The only thing that troubled the UCLA pediatric rheumatologist with her "diagnosis" was that it lasted so long, because she said this type of reactive arthritis usually goes through fairly quickly. Well, here we are a year later, he just spent the last month fighting a sinus infection, strep and staph in the throat, and another sinus infection (4 different antibiotics). He finally feels better (last Tuesday), plays a couple of hours at the park with his buddies, and then his achilles starts bugging him. By the next day he can't walk on it at all, and now even in the boot (from last year) he has pain. Today the 2nd achilles goes down. I am not sure what to do for him. We are going to pediatrician tomorrow, so I guess we'll see what she says.

 

Have you seen this type of tendonitis last so long in a post strep situation?

 

Every one of the patients I dealt with were better in 2-4 days, it was like a script .... Because strep can be persistent, it's not inconcievable that it could last much longer, but what happened to your son may well be something different. Was he checked for HLA-B27?

 

Dr. T

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I am wondering if anyone has had a child who has had acute tendonitis after bouts of strep? My son has had this happen twice now, once last year and now again this week. He had strep prior both times. We saw a specialist at UCLA last year when it happened and her best guess was that it was a response to him having had strep a month prior to the tendonitis. This time, the tendonitis came on a few days after finishing the antibiotics for the strep.

 

I inadvertently posted this on the wrong topic ADHD, so sorry for the multiple post.....

 

This is a very common but sorely under-recognized finding post-strep - in NJ we had an epidemic of acute post-streptocoocal enthesopathy over the past two years. Almost invariably involving bilateral knee and ankle joints with sufficient pain that many of these children refused to walk (and so neurology was called a lot). Everyone went from mild-severe-mild pain over the course of 1-3 days. Although this can possibly be viewed as a minor version of rheumatic fever (no fever, no rash, no heart involvement, just the rheumatic), it's different as that is usually over joints, and this is over tendons.

 

There is almost nothing about this in the literature - so there's another paper to write Sigh.

 

If others can confirm, this might be considered to be another strep warning sign to look out for ....

 

Dr. T

[/quot

 

When this happened to him last year, it started in one achilles tendon and they booted him. After about 2 weeks in the boot (with no improvement) his other achilles went. That's when they started talking auto immune disorders, and ordering bloodwork. Nothing really showed up except that he had obvious inflammation. Ibuprofen around the clock didn't help either. He was booted on the other leg too, but eventually had to have a wheelchair because he felt pain even in the boots. After about a month total, it went away. Only to reappear right before we went to UCLA in the underside of his elbow (which lasted less than 24 hours) and then the next day in the tendon on his wrist, which also lasted less than a day.

 

The only thing that troubled the UCLA pediatric rheumatologist with her "diagnosis" was that it lasted so long, because she said this type of reactive arthritis usually goes through fairly quickly. Well, here we are a year later, he just spent the last month fighting a sinus infection, strep and staph in the throat, and another sinus infection (4 different antibiotics). He finally feels better (last Tuesday), plays a couple of hours at the park with his buddies, and then his achilles starts bugging him. By the next day he can't walk on it at all, and now even in the boot (from last year) he has pain. Today the 2nd achilles goes down. I am not sure what to do for him. We are going to pediatrician tomorrow, so I guess we'll see what she says.

 

Have you seen this type of tendonitis last so long in a post strep situation?

 

Every one of the patients I dealt with were better in 2-4 days, it was like a script .... Because strep can be persistent, it's not inconcievable that it could last much longer, but what happened to your son may well be something different. Was he checked for HLA-B27?

 

Dr. T

 

I believe so..... is that the one for spondylitis? It sounds familiar, and it was negative, although I know it had something like a 20% false negative rate? Every blood test for any type of specific autoimmune disorder came back negative. When you say strep is persistent.... do you mean that maybe he still has strep in his system? Because that's what we thought last month when the sore throat went away, but then the sinus infection popped back up. The pediatrician thought that either staph, strep or both were lurking in the fluid in his sinuses. We did sinus rinses twice a day and it cleared out a ton of gunk, and then he seemed to finally get better (more energy, cough went away). They also did a nasal swab at that time, and it didn't show anything.

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