Rheumatic fever

Question 1

define rheumatic fever?

Answer 1

• An inflammatory multisystem disorder, in response to a recent Streptococcus pyogenes infection.

Question 2

epidemiology of rheumatic fever?

Answer 2

• Common in developing countries but increasingly rare in the West

Question 3

when does rheumatic fever present?

Answer 3

• 2-5 weeks after pharyngeal GAS infection

Question 4

presenting symptoms of rheumatic fever?

Answer 4

•	General
o	Malaise 
o	Fever
o	Anorexia
•	Joints
o	Painful, swollen
o	Reduced movement/function
o	Cardiac
o	Breathlessness
o	Chest pain
o	Palpitations

Question 5

how is rheumatic fever diagnosed?

Answer 5

the revised Jones criteria

Question 6

what is the revised jones criteria?

Answer 6

o There must be evidence of recent strep infection + 2 major criteria OR 1 major + 1 minor criteria

Question 7

what is evidence of a recent strep infection?

Answer 7

o Raised or rising streptococci antibodies
o Positive throat swab
o Positive rapid group A streptococcal antigen test

Question 8

what are the major criteria?

Answer 8

o Carditis: tachycardia, murmurs (mitral/aortic regurgitation), pericardial rub, cardiomegaly, conduction defects
o Arthritis: usually affects larger joints
o Subcutaneous nodules: small firm painless nodules seen on extensor surfaces, joints and tendons
o Erythema marginatum: geographical-type rash with red, raised edges and clear centre mainly on trunk and proximal limbs
o Sydenham’s chorea: rapid, involuntary, irregular movements with flowing/dancing quality

Question 9

what are the minor criteria?

Answer 9

o Pyrexia
o Raised ESR/CRP
o Arthralgia (only if arthritis not present as major criteria)
o Prolonged PR interval (only if carditis not present as major criteria)
o Previous rheumatic fever

Question 10

what investigations should be done for rheumatic fever?

Answer 10

•	Bloods: 
•	Throat swab:
•	ECG: 
o	saddle-shaped ST elevation and PR segment depression 
•	Echo

Question 11

what should be taken on the bloods?

Answer 11

o FBC (inc WCC)
o inc ESR/CRP
o rising antistreptolysin
o O titre