ARF Flashcards
- multisystem disease resulting from an autoimmune reaction to infection with GAS
- cardiac valvular damage (rheumatic heart disease [RHD]), which may persist after the other features have disappeared
ARF
GLOBAL CONSIDERATIONS
- ARF and RHD are diseases of poverty
- RHD is the most common cause of heart disease in children in developing countries
- major cause of mortality and morbidity in adults
- 95% of ARF cases and RHD deaths now occur in developing countries
- ARF is mainly a disease of children age
- peaks between
- 5-14 years
- 25 and 40 years
ARF is exclusively caused by infection of the upper respiratory tract
with
GAS
appear to be associated with susceptibility
HLA-DR7 and HLA-DR4
class I] alleles have been associated with protection
- HLA-DRS,
- HLA-DR6,
- HLA-DR51,
- HLA-DR5S2,
- HLA-DQ
Associations have also been described with polymorphisms at the ___, high levels of circulating mannose-binding lectin, and Toll-like receptors
tumor necrosis factor a locus (TNF a-308 and TNF-a-238)
latent period of ARF
3 week (1-5 weeks)
Clinical Features of ARF
- Polyarthritis (60-75%)
- carditis (50-60%)
Erythema marginatum and subcutaneous nodules are now rare, being found in
<5% of cases
Up to 75% of patients with ARF progress to
RHD
hallmark of rheumatic carditis
Valvular damage
is almost always affected
mitral valve
characteristic manifestation of carditis in previously
unaffected individuals is ____, sometimes
accompanied by ____
- mitral regurgitation
- aortic regurgitation
WHF Criteria for Echocardiographic Dx of RHD in Individuals <20 y.o
DEFINITE RHD
- Pathologic MR and at least two morphologic features of RHD of the mitral valve
- MS mean gradient 4 mmHg (note: congenital MV anomalies must be
excluced) - Pathologic AR and at least two morphologic features of RHD of the AV note: bicuspid AV and dilated aortic root must be excluded
- Borderline disease of both the MV and AV
WHF Criteria for Echocardiographic Dx of RHD in Individuals <20 y.o
BORDERLINE RHD
- At least two morphologic features Of RHD of the MV without pathologic MR or MS
- Pathologic MR
- Patholorgic AR
WHF Criteria for Echocardiographic Dx of RHD in Individuals <20 y.o
NORMAL ECHOCARDIOGRAPHIC FINDINGS
ALL 4
- MR that does not meet all 4 Doppler criteria (physiologic MR)
- AR that does not meet all 4 Doppler criteria (physiologic AR)
- An isolated morphologic feature of RHD of the MV (e.g valvular thickening without any associated pathologic stenosis or regurgitation
- Morphologic feature of RMD of the AV (e.g valvular thickening) w/o any associated Pathologic Stenosis or regurgitation
most common form of joint involvement in ARF
Arthritis