Acute rheumatic fever

Acute Rheumatic Fever

Acute rheumatic fever (ARF) - acute autoimmune disease etiology- group A beta-hemolytic streptococcal infection.
It is characterized by inflammatory lesions of connective tissue and endothelial tissue, primarily affecting the joints and heart.

Major Jones criteria, Minor Jones criteria, Carditis, Subcutaneous Nodules, Erythema marginatum, Sydenham's chorea ,

Pathophysiology and Etiology

Most first attacks of ARF occur 1 to 5 weeks (average 3 weeks) after a streptococcal infection of the throat or of the upper respiratory tract.
Family history of rheumatic fever is usually positive.
Clinical Manifestations
several weeks by fever, malaise, and anorexia.
Major symptoms of ARF may appear several weeks to several months after initial infection.

Diagnosis can be done with jone's criteria

Major Jones criteria
Minor Jones criteria

Major Jones criteria include the following:

Mnemonic : CASES

1️⃣ Carditis (inflammation of the heart)

which occurs in 60% of patients, is the most severe symptom of ARF and can result in permanent damage to the heart valves, heart muscle itself, or tissue surrounding the heart (pericardium).
These effects can be life threatening.

2️⃣ Arthritis or migratory polyarthritis (joint inflammation),

which is usually the first presenting symptom of ARF, occurs in 45% of patients.
Large joints (knees, ankles, elbows, and (wrists) are the most commonly affected.
The pain may be moderately painful.

3️⃣ Subcutaneous Nodules :

Some people have small, form, painless lumps beneath the skin that are common around the wrists, elbows, and knees.
These are present in only about 2% if affected people.

4️⃣ Erythema marginatum :

The rash is wavy and has a snakelike appearance (serpiginous) that has distinct erythematous (red) borders or "margins."
The rash is not itchy or painful, starts on the trunk, and expands to involve the extremities & It does not affect the face.
occurs in 5% of patients.

5️⃣ Sydenham's chorea

occurs in 30% of patients and is a movement disorder comprising of uncontrollable, purposeless, volatile movements of the face
and arms.
This was also called St. Vitus' dance, which was named after the patron saint of the "mania dancers" of the middle ages.
This movement disorder is characteristic of ARF and may be associated with emotional disturbances and inappropriate behaviors.
This movement disorder may appear months

Minor Jones criteria include the following:

Mnemonic : Frapp

1️⃣ Fever

- is often present during the acute infection with group A strep and is present during the initial phase of rheumatic fever.

2️⃣ Raised ESR & CRP

- Nonspecific laboratory changes of inflammation: elevated white blood cell (WBC) levels, elevated erythrocyte sedimentation rate (ESR), and elevated C-reactive protein (CRP)

3️⃣ Arthralgia

- sore joints without evidence of swelling, warmth, or associated skin changes ,Previous rheumatic fever or rheumatic heart disease

4️⃣ Prolonged P-R Interval

Characteristic changes on an electrocardiogram (EKG)

5️⃣ Previous Rheumatic Fever .

Diagnostic criteria - 2 Major manifestation or 1Major manifestation + 2 minor manifestation

ECG done to evaluate PR interval and other changes.
Laboratory tests group A streptococcal culture and /or antistreptolysin-O titer to detect streptococcal antibodies from recent infection.
Chest X-ray for cardiomegaly, pulmonary congestion, or edema.

Management -

Course of antibiotic therapy to completely eradicate streptococcal infection

Bed rest during the acute phase (until ESR decreases, C reactive protein be negative, and pulse rate returns to normal) to rest the heart.
Bed rest may need to be maintained for 2 to 4 months in cases of severe carditis.
Mitral valve replacement may be necessary in some cases.
Secondary prevention of recurrent ARF:
Risk of recurrence greatest within the first 5 years, with multiple episodes of and with rheumatic heart disease. Prophylactic antibiotic treatment is lifelong.

Complications