Rheumatic Fever

Question 1

what is rheumatic fever

Answer 1

autoimmune condition which develops 2-4 weeks post group A streptococcal infection

Question 2

which is the most commonly associated microorganism in rheumatic fever

Answer 2

streptococcus pyogenes

Question 3

symptoms of rheumatic fever

Answer 3

high grade fever

joint pain (migrating polyarthritis - starts at distal large joints and moves proximally)

chest pain, SOB, palpitations (carditis (pericarditic, myocarditis))

Question 4

which valve is most commonly affected by rheumatic fever

Answer 4

mitral (regurgitation)
associated with repeated attacks

Question 5

what are some complications of rheumatic fever

Answer 5

mitrl regurgitation
AF
HF
infective endocarditis

Question 6

signs on examination of rheumatic fever

Answer 6

erythema marginatum (non itchy rash with red outline and clear centre)

subcutaneous nodules on extensor surfaces

Sydenham’s chorea

Question 7

major jones criteria

Answer 7

J - joint pain (migrating polyarthritis)
O - carditis
N - nodules
E - erythema marginatum
S - Sydenham’s chorea

Question 8

minor jones criteria

Answer 8

C - CRP raised
A - Arthralgia (not migrating)
F - fever
E - ESR raised
P - prolonged PR
A - Hx suggestive of rheumatic fever
L - leucocytosis

Question 9

what investigations should be done when considering rheumatic fever

Answer 9

ECG (often have heart block)
CXR
Echo
Serology (anti streptolysin O)

Question 10

treatment of rheumatic fever

Answer 10

symptom relief
analgesia (paracetamol preferably, as NSAIDs can mask joint pain)
ABX
Cardiac monitoring - HF, heart block

Question 11

which ABX are first line in rheumatic fever

Answer 11

IM benzathine benzylpenicillin
PO erthryomycin