Rheumatic Fever
Rheumatic Fever
Rheumatic Fever
RF
INTRODUCTION
In 1930s strong association between
tonsillopharyngitis and scarlet fever epidemics
with acute RF lead to the diagnosis and
management protocol
Leading cause of acquired heart disease in
children/young adults
Now classified as CT/collagen vascular disease
Incidence Developing countries 100/100000
USA/Europe 2/100000
DEFINITION
Recurrent attack of rheumatic fever Two major or one major and two minor manifestations
in a patient without established plus evidence of preceding group A streptococcal
rheumatic heart disease infection
Recurrent attack of rheumatic fever Two minor manifestations plus evidence of preceding
in a patient with established group A streptococcal infectionc
rheumatic heart diseaseb
Polyarthritis
Chorea
Erythema marginatum
Subcutaneous nodules
cSome patients with recurrent attacks may not fulfil these criteria.
e1992 Revised Jones criteria do not include elevated leukocyte count as a laboratory
minor manifestation (but do include elevated C-reactive protein), and do not include
recent scarlet fever as supporting evidence of a recent streptococcal infection.
RHEUMATIC CARDITIS
Signs of CCF
Prolonged PR in ECG
RHEUMATIC ARTHRITIS
Most common /non specific manifestation
Affect >80% of RF patients
Acute non suppurative migratory polyarthritis
Affect bigger joints
Knee/ankle/elbow/wrist/shoulder
Painful ,asymmetric ,transient and migratory
Usually benign self limiting
Usually no permanent sequelae
Inflammatory changes without infection joint fluid
CHOREA (ST VITUS DANCE/SYDENHAMS )
Extra pyramidal disorder characterised by sudden
irregular ,quasipurposive (dance like),non repetitive
involuntary movements
Movements increase in stress/awake ,disappear in
sleep
Present as involuntary movements of
hands/face/limbs with hypotonia ,difficulty in
writing /talking/walking
Delayed manifestations of RF (>3 m)in 80% RF
patients ;Most have benign course /complete
resolution
SUBCUTANEOUS NODULES
Leukocytosis
Thrombocytosis
Normochromic/Hypochromic anemia
Leukocytosis
Thrombocytosis
- Treatment of CCF
- Prevention of IE
Rheumatic chorea
CCF
IE
VHD
Chorea
IMPORTANT POINTS IN RF
5% RF persist for > 6 months (chronic RF ) and
they develop significant carditis /chorea
All cases of RHD manifest in < 6 months
Steroids in RF pericarditis ,CCF
Jaccouds arthritis Deformities in fingers and
toes
RF licks the joints and bites the heart
Recurrent fresh attacks of RF is common in
endemic areas