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19th June 2024
Rheumatic fever
Rheumatic fever occurs as a result of autoimmune phenomena 2-4 weeks after group A streptococcal infection.
Diagnosis
Diagnosis is based on the revised Jones criteria. This entails evidence of recent streptococcal infection as well as 2 major criteria, or 1 major and 2 minor.
| Major criteria |
|---|
| Evidence of recent streptococcal infection (1 of the following): |
| Positive throat culture for group A beta-haemolytic streptococci |
| Positive rapid streptococcal antigen test |
| Elevated or rising antistreptococcal antibody titre – Either Anti-Streptolysin O (ASO) or Anti-Deoxyribonuclease B (ADB) |
| Evidence of Major criteria (1 of the following): |
| Arthritis – usually migratory polyarthritis involving large joints |
| Carditis or Valvulitis (i.e. pancarditis), this can be clinical or subclinical |
| CNS involvement (e.g. Sydenham’s chorea) |
| Subcutaneous nodules |
| Erythema marginatum |
| Minor Criteria |
| Arthralgia |
| Fever |
| Elevated acute phase reactants (ESR or CRP) |
| Prolonged PR interval on ECG |
Treatment
This is based on eradication of GAS, often IM penicillin G is used. Thereafter, treatment is supportive, with prophylaxis against future infection.
References
- Wilkinson IE, Raine T, Wiles K, Goodhart A, Hall C, O’Neill H. Oxford Handbook of Clinical Medicine (10th ed.). Oxford (UK): Oxford University Press; 2017
- Steer A, Sundel R, TePas E. AF, Calderwood SB, Baron EL. Acute rheumatic fever: Clinical manifestations, diagnosis, treatment and prevention. In UpToDate, TePas E (Ed), UpToDate, Waltham, MA. (Accessed May 2022)
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