Other

Question 1

What is Rheumatic Fever?

Answer 1

Acute autoimmune inflammatory multi-systemic illness mainly affecting children 5 - 15 yo*

symptomatic or asymptomatic infection with GABHS Group A ß-Hemolytic Streptococcus* (aka Strep pyogenes) stimulates antibody production to host tissues & damages organs directly. The infection usually precedes the onset of rheumatic fever by 2 - 6 weeks

Question 2

Complications of Rheumatic Fever

Answer 2

rheumatic valvular disease: mitral* (75 - 80%), aortic (30%)’ tricuspid and pulmonic (5%)

Question 3

Diagnosis of Rheumatic Fever

Answer 3

Clinical Diagnosis using the 2015 Jones Criteria

2 Major OR 1 major + 2 minor

1. Joint (migratory polyarthritis)

2. Oh my heart (active carditis)

3. Nodules (subcutaneous)

4. Erythema Marginatum

5. Sydenham’s chorea

Minor Criteria:

Fever (> 101.3)

Arthralgia

Laboratory – î acute phase reactants (îESR, CRP, leukocytes)

ECG: prolonged PR interval

PLUS: supporting evidence of a recent group A streptococcal infection (positive throat culture or rapid antigen detection test &/or elevated/increasing streptococcal antibody titers ASO)

Question 4

Major Criteria of Rheumatic Fever

Answer 4

1. POLYARTHRITIS: (75%) 2 or more joints affected (simultaneous more diagnostic) or migratory (lower ⇒ upper joints). Medium/large joints MC (knees, hips, wrists, elbows, shoulders). Heat, redness, swelling, severe joint tenderness must be present. Joint pain (Arthralgia) without other symptoms doesn’t classifiy as major. Usually lasts 3 - 4 wks

2. ACTIVE CARDITIS: (40 - 60%) can affect valves (especially mitral & aortic), myocardium (myocarditis), &/or pericardium (pericarditis). Carditis confers great morbidity & mortality

3. SYDENHAM’S CHOREA: (< 10%) “Saint Vitus Dance” may occur 1 - 8 months after initial infections. Manifestations include sudden involuntary, jerky, non-rhythmic, purposeless movements, especially involving the head/arms. Usually resolves sponaneously, MC in females

4. ERYTHEMA MARGINATUM: often accompanies carditis. Macular, erythematous, non-pruritic annular rash with rounded, sharply demarcated borders (may have central clearing). MC seen primarily on the trunk & extremities (not the face). Crops last hours-days before disappearing.

5. SUBCUTANEOUS NODULES: rare. seen over joints (extensor surfaces), scalp & spinal column

Question 5

Management of Rheumatic Fever

Answer 5

1. Anti-inflammatory: Aspirin (2 - 6 wks with taper); + corticosteroids in severe cases & carditis
2. Penicillin G antibiotic of choice (or Erythromycin if PCN-allergic) both in acute phase & after acute episode. Prevention is the most important therapeutic course. Therefore all patients (even if presenting with acute rheumatic fever) should be treated with antibiotics.