Orthopaedic Jobs

Acute Rheumatic Fever


- 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.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, August 21, 2012 3:53 pm