Rheumatic fever 3.67/5 (3)

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Definition

Rheumatic fever is acute, painful arthritis (arthritis) which can affect children from 5 years of age. The cause is a 2-3 weeks prior untreated infection with streptococci. The condition is also called gout fever. In addition to the manifestations of joint, heart disease is a dreaded complication.

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

Rheumatic fever is triggered by the immune system as a result of a reaction to β-hemolysing group A streptococci (GAS) in predisposed children. These bacteria trigger tonsillitis (inflammation of the tonsils), less commonly inflammation of the skin. However, the disease mechanisms are not fully understood (Reference: Carapetis JR, 2016). 

Symptoms

Most people who get rheumatic fever are children between 5 and 14 years of age. Girls are attacked a little more often than boys.

Fever and fatigue

Symptoms typically begin 2-3 weeks after a throat infection combined with arthritis. High fever and fatigue are common.

Arthritis

Typically are strong joint pain and then new severe arthritis (Arthritis) in one knee, ankle, elbow or wrist. It is common for arthritis to move from joint to joint (migrating arthritis). Most people with rheumatic fever develop such arthritis.

Heart disease

Myocarditis (myocarditis) and inflamed heart valves (most often the mitral valve) are seen in 50-70%.

The brain

Central nervous system and brain can be attacked in the form of Sydenham's chorea with uncontrolled movements. In addition, changed behavior is seen. These are late symptoms that begin 1-6 months after throat infection. At this point, the other symptoms may have completely gone back, so one easily overlooks a connection. About 20% are attacked.

Skin and subcutaneous tissue

Rash is seen in about 5% with rheumatic fever. Erythema marginatum or nodules under the skin (nodules) are characteristic.

Examinations

Medical history charts symptoms of prior signs of upper respiratory tract infection, latency before fever and onset of joint symptoms (migratory / migrating arthralgia and / or arthritis are typical).

Clinical made one general examination which includes the pharynx, skin (rash, nodules), joints (arthritis), heart (heart muscle, valve disease), nervous system (encephalitis), kidneys and other organs. Joint pain (arthralgia) and swollen, hot joints (Arthritis) is detected by medical examination and imaging (see below).

Blood tests may routinely include CRP, SR, leukocytes with differential counts, anti-streptolysin titer (AST)

Urine: stick.

Imaging with ultrasound and MRI scans of paragraph is relevant.

Other. The heart can be assessed by ECG and echocardiography for current symptoms. Neurological specialist assessment for symptoms.

Diagnostic criteria (Szylgieska I, 2018)

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

Main criteria

  1. Polyarthritis (arthritis in several joints, most often in large joints)
  2. Cardiac muscle inflammation (peri-, myo-, endocarditis) and heart valve manifestation
  3. Neurological: Chorea minor (Sydenham) (extrapyramidal hyperkinesia, hypotension)
  4. Eczema: Erytehema anulare (pale red, annular, most common on the body, 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

Similar diseases / differential diagnoses

Treatment

Paracetamol or Naproxen is used for pain. In case of inflammation of the heart, corticosteroids are given. Penicillin may be topical, also as a prophylaxis (recurrence prophylaxis). Some people recommend stopping treatment after 7 years of prophylaxis if patients have reached the age of 25. However, if the heart has been attacked, prevention is up to 30-35 years of age in moderate manifestations and up to 40 years of age in the history of severely related heart disease (Carpetis JR, 2005).

Prognosis

The joint and skin symptoms go away after a few weeks. Heart disease can be problematic and is the cause of long-term prevention with Penicillin.

Literature


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