Lots of questions...ASO and arthritis flares

Hi everyone.  I'll try to keep this as brief as I can.  My 9 yr old son has JRA and has had it for about 2 years.  This past fall he was put on Celebrex and it was finally something that helped a lot and he did incredibly well until about 3 weeks ago.  He got two cases of the flu within 2 weeks and  then his arthritis flared.  I have been having to help him out of bed in the mornings and help him get dressed because of the pain.  I took him to his pediatritian on Thursday because he was in so much pain (his pediatirc rheumy is in another state). She ran labs and he is anemic (as usual), his sedimentation rate was pretty elevated at 55 and she ran an ASO which was really high at 899.  The ASO measures the strep antibody, but he had no strep symptoms even during his flu.  This has happened before with the ASO when his arthritis was flaring.  He is susceptible to strep, but he usually has a sore throat with it.  I tried to do some reading about ASO and found some stuff that said it might also correlate with arthritis flares.  The other possibility is that he developed rheumatic fever due to strep and if so, I am really worried because that can affect the heart and kidneys.  I probably need to call the pediatric rheumy - the pediatrician is going to fax the labs to him.  For now he will start antibiotics and get his ASO re-tested Has anybody else had elevated ASO titers or understand how it might play into arthritis?  Can anyone help me with what might be going on with my son?  Thanks

Hi Hippimom,

I wasn't aware of ASO titers and arthritis being related, but I have been told by multiple doctors that any virus can cause an arthritis flare. OF course, that may be what they say when they don't know what's wrong? I've had elevated ASO titers before, but I had strep throat--my whole family did (last spring). Haven't had my ASO titers measured recently, so I don't know if it's still elevated, but I would imagine not. My nephew had rheumatic fever a couple of years ago. He got strep throat, and about a week later his joints all swelled and he got a pretty bad rash. It was pretty scary, especially for my poor sister. He has been followed up by a pediatric rheumatologist and cardiologist, but has had no problems so far. He is kept on low dose penicilin (I think) to keep strep at bay because he is also very susceptible to it. Unfortunately, he's still caught it a couple of times with no discernible symptoms. I think your son's doctor is on to something with the ASO; if your son has strep and a rheumatoid condition this could be his problem and it needs to be addressed. My nephew almost wasn't diagnosed with it because no one expected rheumatic fever these days, but evidently it is making a come-back in this country. The good news is that my nephew is fine, just takes an antibiotic and is an otherwise very normal and active little boy.

I hope your son is feeling better soon,
El