Acute Rheumatic Fever Clinical manifestations

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Acute Rheumatic Fever
Acute rheumatic fever

Acute Rheumatic Fever

Acute Rheumatic Fever: Is a systemic disease characterized by inflammatory lesions of connective and endothelial tissue.

Etiology :

  • The exact pathogens of Acute Rheumatic Fever are unknown.
  • It is thought to be an autoimmune response to group a beta-hemolytic streptococcus.
  • Most first attacks of rheumatic fever preceded by streptococcal infection of the throat or upper respiratory tract at an interval of several days to several weeks.

Altered physiology of Acute Rheumatic Fever:

  • The unique pathologic lesion of rheumatic fever is the Aschoff body.
  • The basic changes consist of exudative and proliferative inflammatory reactions in the mesenchymal supporting tissues of the heart, joints blood vessels and subcutaneous tissue.
  • The inflammatory process involves all layers of the heart.
  • The inflammatory may involve the heart valves, most frequent the mitral and/or the aortic valves.

Clinical manifestations :

  • The diagnosis is based on a combination of manifestations of the disease.
  • The presence of 2 major criteria or 1 major and 2 minor criteria, plus evidence of preceding streptococcal infection are required to establish the diagnosis.

Major manifestations of Acute Rheumatic Fever  :

1- Carditis: significant murmurs, signs of pericarditis, cardiomegaly or congestive heart failure.

2- Polyarthritis: the affected joints are swollen, tender and red migratory, the large joints are affected.

3- Subcutaneous nodules :

  • Firm, painless bodies seen or felt over the extensor surface of certain joints, particularly the elbow, knee, and wrists.
  • Disappear mostly after 4 months.
  • Presence of nodules is an indicator that the heart is involved.

4- Erythema marginatum :
Circinate or annular rash occurs on the arms, trunk, and legs { never on the face}. evanescent, pink rash, have pale centers and round or wavy margins.

5- Chorea: Purposeless involuntary movement often associated with muscle weakness, incoordination of voluntary movement and emotional instability.

Minor manifestations of Acute Rheumatic Fever  :

1- Fever. The average normal body temperature is 98.6°F (37°C).

2- Arthralgia.

3- Prolonged P-R interval in the ECG.

4- Increased E.S.R, leukocytosis, positive C-reactive protein (CRP).

5- A history of streptococcal infection, scarlet fever, previous history of rheumatic fever.

Treatment of Acute Rheumatic Fever :

1- Bed rest for 2 weeks then gradual ambulation ( bed rest is a large part of the treatment).

2- Cases without cardiac involvement, aspirin only 100 mg/kg/day in 4 hours divided doses . until E.S.R. (erythrocyte sedimentation rate) is normal for 2 weeks. The normal range for E.S.R. is 0-22 mm/hr for men and 0-29 mm/hr for women.

3- With cardiac involvement aspirin and prednisone.

4- Prevention of rheumatic fever through control of streptococcal infection: procaine penicillin G 1.200.000 units once a month (the drug of choice for streptococcal infection).

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