Whelan JP. Strep Throat and the Backstory for PANS and PANDAS. JAMA Netw Open. 2024;7(7):e2421636. doi:10.1001/jamanetworkopen.2024.21636
- Longitudinal analysis (Ma et al.) of 193 children with PANS revealed that 28% developed arthritis over 4 years, showing unusual rheumatic profiles like Achilles enthesitis (56%), inflammatory back pain (64%), and sacroiliac joint tenderness (69%). Only 2% had typical childhood arthritis.
- Back pain is a common concern among Whelan’s 600 families, often challenging to differentiate true spondyloarthropathy from pain amplification due to poor sleep, which almost all PANS patients experience.
- Ultrasonography in 40 children found effusions or synovitis, suggesting real back arthritis in many.
- A high prevalence of antihistone antibodies (20%) may result from multiple medications. 55% of children with PANS also had a coincident eating disorder.
- Frequent infections in two-thirds of these children may explain elevated inflammatory markers and the abrupt onset of tics, OCD, and behavioral issues, possibly due to “PANDA-genic” bacterial strains in genetically susceptible hosts.
Gabriella True
