Rheumatic Fever

Question 1

Rheumatic fever pathology

Answer 1

Group A beta-haemolytic strep triggers RF 2-4 weeks later in susceptible 2% of pop
Ab to cell wall of strep cross reacts with valve tissue

Question 2

Rheumatic fever diagnosis

Answer 2

Revised Jones criteria

Evidence of recent strep infection + 2 major criteria or 1 major + 2 minor

Question 3

Revised Jones criteria evidence of strep

Answer 3

+ve throat culture
Rapid strep antigen test +ve
Elevated strep Ab titre
Recent scarlet fever

Question 4

Revised Jones criteria major criteria

Answer 4

Carditis
Arthritis

Subcut painless nodules on extensors/ spine
Erythema marginatum

Sydenham’s chorea

Question 5

Revised Jones criteria minor criteria

Answer 5

Fever
Raised ESR/CRP

Arthralgia (not if arthritis one of major)
Prolonged PR interval (not if carditis is one of major)

Previous rheumatic fever

Question 6

Rheumatic fever management

Answer 6

Bed rest until CRP normal for 2wks
Immobilise joints in severe arthritis

Benzylpenicillin 0.6-1.2g IV stat then phenoxymethylpenicillin 250-500mg 4x/d PO for 10d

Analgesia, aspirin 100mg/kg/d (up to 4-8g/d)
+oral pred if moderate-severe carditis
Haloperidol 0.5mg/8h or diazepam for chorea

Question 7

Rheumatic fever prognosis

Answer 7

60% develop chronic rheumatic heart disease

Recurrence with strep infections, prgenancy, OCP

Question 8

Rheumatic fever 2˚ prophylaxis

Answer 8

Penicillin V 250mg/12h PO
Erythromycin 250mg 2x/d if pen allergic

Continue for 5yrs if no carditis
10yrs if carditis but no valvular disease
Until 40 if valvular disease