- Discussion:
- autoimmune reaction ocurring 2-4 weeks after streptococcal infection (URI or tonsillitis);
- ages 5-15 yrs are most susectible; (younger pts are rarely affected)
- diagnosis:
- its rapid response to ASA is almost diagnostic;
- increased ASO titer, positive throat culture for group A strep, recent scarlet fever & h/o preceding streptococcal infection;
- dramatic response to salicylates gives additional support for dx;
- diff dx
- clinical presentation:
- rheumatic fever lasts less than 6 weeks;
- arthritis: (usually lasts less than 6-12 weeks);
- migratory arthritis:
- joints are exquisitely tender, red, and hot;
- arthritis migrates from joint to joint over a period of hours;
- erythema marginatum (associated w/ carditis & rarely seen in adults);
- pink rash on trunk & extremities but not face;
- present in only a minority of patients;
- rheumatic nodules:
- fever;
- carditis;
- in children w/ rheumatic fever, cardiac involvement is dominant finding but adults may present w/ abrupt onset of polyarthritis & fever;
- about a third have no recollection of pharyngitis;
- presence of two major criteria or one major and two minor criteria indicates a high probability of rheumatic fever;
- minor manifestations:
- fever, arthralgia, previous R.F.
- acute phase reaction
- elevated ESR
- elevated C reative protein
- leukocytosis
- incr PR interval
- major manifestations:
- carditis
- polyarthritis
- chorea
- erythema marginatum
- subcutaneous nodules
- Synovial Fluid Exam
- Diff Dx:
- four conditions which may cause an excruciatingly painful joint.
- rheumatic fever,
- septic arthritis
- gout or, rarely, pseudogout;
- bone or soft tissues tumor;
- Reiter's syndome (resulting from yersinosis) may resemble rheumatic fever;
- JRA:
- joint arthritis in JRA is often more persistent and last longer than seen in ARF (6 to 12 weeks);
- Treatment:
- treatment includes salicylates and appropriate antibiotics;
- w/o treatment, fever usually fluctuates without returning to normal for a week or more.
- carditis: treated w/ steroids;
- recurrence: prevent w/ penicillin prophylaxis
Review Article: Current Concepts: Polyarthritis and Fever.