Rheumatic Fever

Rheumatic Fever

Pathology:     Systemic inflammatory disease occurring 2-4weeks after pharyngeal infection

with group Abeta haemolytic Streptococcus pyogenes


Aetiology:      Autoimmune antibody-antigen complex whichwere produced against the Streptococcus

pyogenes cell wall and proteins on cardiacvalves. It affects heart, joints, skin and brain.  Peak age 5-15 years


Symptoms:    Polyarthritis,heart failure, fever, joint pain, involuntary movements, sore throat


Signs:                Symptoms of valvedysfunction, subcutaneous nodules, erythema marginatum,


Investigations:          Bloods: FBC, CRP, Anti-streptolysin O titre, DnaseB titre

                                          Throatswab: screens for pharyngitis

ECG: Prolonged PR

Echo: Assesses valvular and LV function

Histology: Aschoff Bodies:Granulomatous nodules with central necrosis and

fibrinoid degeneration with a cuff of macrophages

Anitschkow Cells: Altered macrophages within Aschoff Bodies with

ribbon like chromatin pattern with thenuclei

Diagnosis: Based on the JonesCriteria. Positive throat swab for Group A Beta

Haemolytic Streptococcus or Elevated anti-streptolysinO titres + 2

major criteria or 1 major and 2 minor criteria


Treatment:                  Acute: Bed rest, analgesia and antibiotics (single dose of IMbenzylpenicillin

otherwise oral penicillin or macrolidefor 10 days.

                                          Symptom Control: NSAIDs or Aspirin forpancarditis or arthritis, however

          NSAIDs can exacerbate heart failure.

           Chorea can be treated with haloperidolor diazepam


Complications:          If untreated progresses to rheumaticheart disease leading to valvular disease


Prognosis:                  60% with carditis develop chronicrheumatic disease or valve dysfunction.

Initial mortality is 1%.

Text Box: 	Jones Criteria For Rheumatic Fever
	Major Criteria
	Joint Involvement: Large joints starting in lower limbs
	Obviously cardiac: Pericarditis with valvular dysfunction and heart failure
	Nodules: Subcutaneous nodules over bony prominences
	Erythema Marginatum: Pink ring rash – not itchy,
	Sydenham Chorea- Jerky involuntary movements affecting head, limbs, or face. 

Minor Criteria
CRP – Raised
Temperature – Raised

History of rheumatic fever
ESR/CRP – Elevated
PR interval - Prolonged

	Mnemonic ‘JONES CAT HELP’



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