rheumatic fever

Question 1

what is the cause of rhumatic fever?

Answer 1

Acute rheumatic fever is an autoimmune condition triggered by streptococcus bacteria. It is caused by antibodies created against the streptococcus bacteria that also target tissues in the body.

Question 2

what ares of the body are affected by rheumatic fever?

Answer 2

multi-system disorder that affects the joints, heart, skin and nervous system. It is rare in the UK due to early treatment of streptococcus with antibiotics.

Question 3

which tyhpe of steptococcal bacteraemia is rheumatic fever most associated with?

Answer 3

group A beta-haemolytic streptococcal, typically streptococcus pyogenes causing tonsillitis.

The immune system creates antibodies to fight the infection. These antibodies not only target the bacteria, but also match antigens on the cells of the person’s body, for example the muscle cells in the myocardium in the heart.

Question 4

how long after initial infection will rheumatic fever develop?

Answer 4

2-4 weeks as it is the result of a type 2 hypersensitivity reaction

Question 5

how does rheumatic fever typically present?

Answer 5

• 2-4 weeks after a step infection (tonsilitis)
• fever
• SOB
• Rash
• chorea
• nodules

can also get migratory arthritis affecting the large joints

Question 6

how does rheumatic fevcer affect the heart?

Answer 6

Carditis, or inflammation throughout the heart, with pericarditis, myocarditis and endocarditis, leads to:

Tachycardia or bradycardia
Murmurs from valvular heart disease, typically mitral valve disease
Pericardial rub on auscultation
Heart failure

Question 7

how does rheumatric fever affect the skin?

Answer 7

Subcutaneous nodules
Erythema marginatum rash

Firm painless nodules occur over extensor surfaces of joints, such as the elbows. The erythema marginatum rash involves pink rings of varying sizes affecting the torso and proximal limbs.

Question 8

how does rheum,atic fever affect the nervous system?

Answer 8

chorea

Question 9

what investigations would you do for rheumatic fever?

Answer 9

Throat swab for bacterial culture
ASO antibody titres
Echocardiogram, ECG and chest xray can assess the heart involvement

A diagnosis of rheumatic fever is made using the Jones criteria

Question 10

what are the jones criteria?

Answer 10

A diagnosis of rheumatic fever can be made when there is evidence of recent streptococcal infection, plus:

Two major criteria OR
One major criteria plus two minor criteria
The mnemonic for the Jones criteria is JONES – FEAR.

Major Criteria:

J – Joint arthritis
O – Organ inflammation, such as carditis
N – Nodules
E – Erythema marginatum rash
S – Sydenham chorea
 Minor Criteria:

Fever
ECG Changes (prolonged PR interval) without carditis
Arthralgia without arthritis
Raised inflammatory markers (CRP and ESR)

Question 11

what is the management for rheumatic fever?

Answer 11

phenoxymethylpenicillin (penicillin V) for 10 days.

NSAIDs (e.g. ibuprofen) are helpful for treating joint pain

Aspirin and steroids are used to treat carditis

Prophylactic antibiotics (oral or intramuscular penicillin) are used to prevent further streptococcal infections and recurrence of the rheumatic fever. These are continued into adulthood.

Question 12

what are complications that can arrise due to rheumatic fever?

Answer 12

Recurrence of rheumatic fever

Valvular heart disease, most notably mitral stenosis

Chronic heart failure