Rheumatic Fever

Question 1

What is rheumatic fever?

What causes it?

Answer 1

Systemic illness that occurs 2-4 weeks after pharyngitis in some people, due to cross-reactivity to group A β-haemolytic streptococcus (GAS), also called Streptococcus pyogenes.

Post-pharyngitis
Beta-haemolytic streptococcus - strep pyogenes

Question 2

What are the Jones diagnostic

Answer 2

2 major criteria
1 major and 2 minor criteria

Plus evidence of preceding strep infection:
Scarlett fever,
Throat swab with beta-haemolytic streptococci
Positive rapid group A streptococcal antigen test

Question 3

What are Jones major criteria?

Answer 3

Erythema marginatum
Sydenham’s chorea: this is often a late feature
Polyarthritis
Carditis and valvulitis (1 of: changed murmur, CCF, cardiomegaly, friction rub, +ve echo)
Subcutaneous nodules

Question 4

What are Jones minor criteria?

Answer 4

Fever
ESR > 20mm or CRP raised
Arthralgia - i.e. pain but no swelling
ECG - PR interval >0.2s
Previous rheumatic fever or rheumatic heart disease

Question 5

What is treatment of rheumatic fever?

Answer 5

Rest/immobilisation helps joints and heart
Aspirin
If severe, get help
Prednisolone may help
Phenoxymethylpenicillin for pharyngitis preceded by one dose of benzylpenicillin