Rheumatic fever

Question 1

Acute rheumatic fever - definition

Answer 1

Acute multisystem inflammatory process occurring 2-3 weeks after Group A streptococcal pharyngitis

Question 2

Rheumatic heart disease - definition

Answer 2

Chronic process due to scarring of valves during acute rheumatic fever with complications such as heart failure and death

Question 3

Rheumatic fever - causative organism

Answer 3

Group A streptococcus - strep pyogenes
Gram positive beta-haemolytic cocci in chains

Question 4

Rheumatic fever - triggers

Answer 4

Group A strep
Environment - health inequity, poverty, access
Susceptible host - 1-2%

Question 5

Rheumatic fever - clinical features

Answer 5

Carditis/valvulitis
Arthritis - migratory large joint arthritis, responds to NSAIDs, non-deforming
Chorea - movement disorder, relief with sleep
Other [major] - subcutaneous nodules, erythema marginatum

Question 6

Jones criteria - Major criteria

Answer 6

Carditis
Arthritis
Chorea
Subcutaneous nodules
Erythema marginatum

Question 7

Jones criteria - Minor criteria

Answer 7

Fever >38.5
Acute phase reactants - ESR >60, CRP >30
Prolonged PR

Question 8

Rheumatic fever - diagnosis

Answer 8

Jones criteria:
Evidence of GAS [swab, rapid test, serology - ASO and Anti-DNaseB rising titre] plus:
2 major or 2 minor and 1 major

Question 9

Rheumatic fever - acute management

Answer 9

Analgesia
Diuresis, ACE-i +/- steroids

Question 10

Rheumatic fever - long-term management

Answer 10

Prevent recurrence
Management of HF
Anticoagulation for AF