Rheumatic Fever

Acute Rheumatic Fever

Multisystem disease resulting from an autoimmune reaction to infection with

group A streptococcus (GAS) infection

2-4 weeks

It appears _____ weeks after a non-treated group A streptococcus (GAS) infection

5 to 14 years old

Usual age range:

Arthritis

• Most common of the major manifestation; occurs in 70% of patients

• most common cause of misdiagnosis of acute rheumatic fever

• Primarily affects the large joints: knees > ankles > elbows and wrists

SYDENHAM'S CHOREA

• persistent involuntary and purposeless movement of the extremities usually symmetric and with muscular inccordination

• most prominent in the face, trunk and distal extremities

• Tongue fasciculation ("bag of worms") → protruded tongue darts in and out

ERYTHEMA MARGINATUM

• Evanescent, pink, nonpruritic, nontender or Irregular border, serpinginous, sharp on the outside, diffuse on the inside edge

• Strongly associated with carditis

SUBCUTANEOUS NODULES

• Predilection for bony surfaces or areas near tendons

• Normally subside within 1 or 2 weeks

• Firm, painless, loose in relation to adjacent surfaces Occur in crops and have symmetric distribution when abundant

• Always associated with significant chronic active carditis

Carditis

develops in about 50% of patients of usually involves the myocardium and

endocardium

Myocarditis

tachycardia at rest in afebrile patient

Endocarditis

valvular insufficiency; mitral valve is affected alone or in conjunction

with other valves in 94% of patients

anti-streptolysin O (ASO)

anti-Dnase B (ADB) titers.

Most Common Serologic test for Rheumatic Fever

Penicillin

Drug of choice for GAS infection to treat SLE

Prednisone

Tx for Acute Carditis

Aspirin

Common forst line of choice for Arthritis, Arthralgia and Fever