Definition

Acute arthritis (arthritis) in children from 5 years 2-XUMX weeks after untreated throat infection with streptococcal A. Also called gout fever. The arthritis is painful and moves from joint to joint. Each joint is attacked for 1-14 days. Rheumatic fever is rare in Western Europe, more common in parts of Africa, Asia and South America.

Disease Causes

• Reaction b-hemolysing Streptococci Group A. These bacteria trigger throat and tonsil inflammation (tonsilitis) inflammation. The disease is a consequence of the immune system's antigen-antibody response to the infection.

Symptoms

Rheumatic inflammation (without infection) that attacks multiple organs.

• • The most common form attacks the joints, causes high fever and cardiac manifestations
  • The rarer type is dominated by slower onset of CNS disease without high fever, and other manifestations may be absent

Joint (over 50%)

• Migrant (Migrant) from paragraphs
• Joint pain
• Arthritis
• Knees, ankles, elbows and wrists

Heart (50-70%)

• Myocarditis
• Heart valve (most often mitral valve)

Skin and subcutaneous tissue (about 10%)

• Erythema marginatum
• Nodes under the skin (nodules)

Central nervous system and brain (CNS, about 20%)

• South Ham's chorea
• Late symptoms. Beginning 1-XNUM months after the throat infection

Investigational Findings

• Joint pain (arthralgia) and swollen, hot joints (Arthritis) is detected by medical examination, ultrasound or MRI examination
• The heart is examined with ECG, blood tests and ultrasound. The mitral valve and the aortic valve
• Skin and nerve manifestations are detected by medical examination

Diagnostic criteria (Szylgieska I, 2018)

Jones (2015): Either at least two main criteria or one main criterion + two minor criteria

Main criteria

1. Polyarthritis (usually in large joints)
2. Cardiac muscle inflammation (peri-, myo-, endocarditis) and heart valve manifestation
3. Chorea minor (Sydenham) (extrapyramidal hyperkinesia, hypotonia)
4. Erythema anulare (pale red, ring-shaped, most common on truncus, volatile)
5. Tummy Tuck (nodules, nodules under the skin)

Minor Criteria

1. Joint pain (arthralgia)
2. Fever
3. ECG changes with prolonged PR interval
4. CRP or lowering reaction (SR) elevated

Incorrect diagnosis (similar diseases, differential diagnoses)

• Other conditions with joint pain in children
• Reactive arthritis
  • Does not attack the heart, nerves or skin.
  • High fever is unusual
• Juvenile Idiopathic Arthritis, JIA
• Septic, infectious arthritis
• Borrelia arthritis

Treatment

• Paracetamol or Naproxen against pain
• In case of heart inflammation, corticosteroids are given
• Penicillin for at least 10 days. Then preventive (recurrent prophylaxis) with long-acting intramuscular Penicillin 1 x / month for 10 years. For safe compliance, tablets are an alternative
• Some recommend treatment at 21 years of age and longer.

Prognosis

• Joint and skin symptoms pass after a few weeks
• The heart disease can be problematic and is the cause of prolonged prevention with Penicillin

Literature

• Web RH, 2015
• Zühlke LJ, 2017
• Great Norwegian encyclopedia

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