Rheumatic Fever

Question 1

discuss acute rheumatic fever

Answer 1

last ~2 wks

multisystemic disease from autoimmune reax to GABHS

resolves completely except for valvular damage

progression in incompletely characterized

Question 2

well established prequel to acute RF

Answer 2

strep pyogenes - sore throat; pharyngitis

Question 3

acute RF that is prolonged

Answer 3

Rheumatic Heart Disease - not chronic

Question 4

discuss cardiac mimicry

Answer 4

pathogens secrete epitopes - mimic heart muscle on diff parts of body

antibodies will attack foreign cells and normal cells

Question 5

incidence of ARF

Answer 5

5-14 yo - MC

rare in > 30 yo

recurrent in adolescent and young adult

no clear gender assoc

Question 6

what makes ARF to RHD

Answer 6

dx of heart damage

Question 7

RHD peaks bet

Answer 7

20-40 yo

females

Question 8

RF major criteria

Answer 8

joint involvement

myocarditis

nodules subcu

erythmea marginatum

sydenham chorea

Question 9

RF minor criteria

Answer 9

CRP inc

arthralgia

fever

elevated ESR

prolonged PR interval

anamnesis of rheumatism

leukocytosis

Question 10

dx of ARF

Answer 10

GAHBS or elevated ASO plus

2 major or 1 major and 2 minor

Question 11

discuss carditis

Answer 11

most deadly - 40-60% results in RHD

usually mitral valve prob less common aortic

can also involve pericardium not just innner

Question 12

discuss polyarthritis

Answer 12

most common and earliest

2-3 wks p onset of RF

inflammation for 1-2 wks then resolves in ≤1 mo

painful migratory usually major joints - tenderness out of proportion to swelling

pwedde din di sabay progression kaya seems migrating

self-limiting but can give pain meds

Question 13

type of polyarthirtis that does not resolve

Answer 13

Jaccoud arthropathy

Question 14

discuss chorea

Answer 14

involuntary, irregular movements - tounge and hands

delayed manifestation: 1-7 p onset

last for mo to years

abolition in sleep

psych probs decades p

recurrences are common

Question 15

discuss subcu nodules

Answer 15

asymptomatic

assoc c pt c mod to severe carditis - several wks p

over major joitns and bones

resolve p 1-2 wks

Question 16

discuss erythema marginatum

Answer 16

in conjunction c carditis

last mo to yrs

seen on trunk and proximal ex - seen early in course of RF

Question 17

tx for ARF

Answer 17

antimicrobial therapy to remove GABHS

antibiotics for secondary prevention
- can span 10-20 yrs
- oral daily or injection q 28 d

anti-inflammatory or aspirin - 1st line of symptomatic therapy