Contents
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.
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- 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
- Polyarthritis (usually in large joints)
- Cardiac muscle inflammation (peri-, myo-, endocarditis) and heart valve manifestation
- Chorea minor (Sydenham) (extrapyramidal hyperkinesia, hypotonia)
- Erythema anulare (pale red, ring-shaped, most common on truncus, volatile)
- Tummy Tuck (nodules, nodules under the skin)
Minor Criteria
- Joint pain (arthralgia)
- Fever
- ECG changes with prolonged PR interval
- 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