A systemic, febrile disease that is inflammatory & non-suppurative in nature & variable in severity, duration & sequelae.
It is acute febrile illness following streptococcal sore throat & characterised by fleeting arthritis, pancarditis, leucocytosis & raised ESR.
Following a streptococcal infection the patient will experience the sudden occurrence of fever & joint pain; this is the most common type of onset. Rheumatic fever may occur without any sign or symptom of joint involvement. Acute rheumatic fever usually affects children (5-15years) or young adults.
Etiology of Rheumatic Fever:
• Streptococcal-A infection.
• Age: 5-15 years
• Sex: more common in females.
• Genetic predisposition noted.
• Over crowding.
• Poor sanitation.
• Cold weather.
Clinical feature of Rheumatic Fever:
Prodormal phase: Tonsillitis or sore throat 1-4 weeks prior to onset of acute rheumatic fever. Vague prodromata include growing pain, anorexia, pallor, fatigability & nervous irritability & low grade febrile attacks.
Latent period: When antibodies to the preceding streptococcal infection are produced.
May vary in length from a few days to several weeks.
Phase of onset of acute rheumatic fever.
• History of sore throat over last 2 weeks.
• Fever with chill.
• Sour perspiration.
• Acute excruciating pain in big joints.
• Swelling of joints.
• Fleeting arthritis:
• Single joint.
• Seldom involved for more than few days.
• No residual trace or deformity remains.
•Another joint gets involved.
• Fast pulse.
• Temperature: 38-39'C
• Rheumatic nodules:- small subcutaneous nodules at bony prominences.
• Erythema marginatum on trunk.
• Knee, ankle, elbow joint affected.
• Affected joint red, hot & swollen.
• Affected joint extremely tender.
• Apex: Feeble.
: In fifth intercostals space, lateral to midclavicular line.
• S1 accentuated in mitral area.
• Soft systolic murmur in mitral area.
Dignosis(DUCKET JONES CRITERIA) for Rheumatic Fever
One major & two minor, or two major & one minor criteria.
• Subcutaneous nodules.
• Erythema marginatum.
• Sydenham’s chorea.
• History of rheumatic fever.
• Raised ASO titre.
• Raised ESR, CRP, TLC, prolonged P-R interval.
Investigation for Rheumatic Fever Blood
• TLC: raised.
• DLC: increased polymorphs.
• ESR: raised.
• ASO titre: raised.
• CRP: raised.
• Positive for group-A ?-haemolytic streptococcus.
ECG shows sign of
• Conduction defects.
• Nothing abnormal.
• Cardiac enlargement.
Differential diagnisis for Rheumatic Fever
• Juvenile rheumatoid arthritis.
• Acute osteomyelitis.
• Henoch-schonlein purpura.
• Acute poliomyelitis.
• Acute leukaemia.
• Streptococcal tonsillitis.
• Sensitivity reaction.
• Collagen disease.
COMPLICATIONS of Rheumatic Fever
• Sydenham’s chorea.
• Cardiac arrhythmia.
• Congestive cardiac failure.
• Mitral stenosis.
General managment of Rheumatic Fever
• Complete bed rest till pulse rate & ESR are high.
• Rest to joint by splints, in position of comfort.
• Gradually initiate activity.
• Diet:- maintain nutrition.
• Restriction of physical activity.