rhuematic fever

Question 1

what is rheumatic fever

Answer 1

autoimmune condition triggered by strep bacteria

caused by antibodies created against strep that also target own tissues

Question 2

pathophysiology

Answer 2

caused by group A beta haemolytic streptococcal, typically strep pyogenes causing tonislitis

antibodies target bacteria and antigens on cell of body

–> T2 hypersensitivity reaction

Question 3

presentation

Answer 3

typically presents 2-4wks after strep infection e.g. tonsilitis

fever
joint pain 
rash 
SOB 
chorea
nodules

Question 4

joint involvement

Answer 4

causes migratory arthritis - different joints become inflamed + improve at different times

Question 5

heart involvement

Answer 5

carditis with pericarditis, myocarditis, endocarditis

• tachycardia or brady
• murmur (usually mitral disease)
• pericardial rub
• hart failure

Question 6

skin involement

Answer 6

subcutaneous nodules

erythema marginatum rash (pink rings of varying sizes)

Question 7

nervous system invovlement

Answer 7

chorea - irregular, uncontrolled and rapid limb movements

Question 8

Investiations

Answer 8

throat swab for bacterial culture
ASO antibody titres
ECHO, ECG, CXR

Question 9

diagnosing rhuematic fever

Answer 9

Jones Criteria

evidence of recent strep infection plus

• two major criteria
  OR
• one major criteria plus 2 minor

Question 10

Jones major criteria

Answer 10

joint arthritis
organ inflammation e.g. carditis
nodules 
erythema marginatum rash
sydenham chorea

Question 11

Jones minor criteria

Answer 11

fever
ECG changes w/o carditis
arthralgia without arthritis
raised inflammatory markers

Question 12

Mx

Answer 12

prevent by treating strep infections with antibx

NSAIDs
Aspirin, steroids
prophylactic antibioitcs

Question 13

complications

Answer 13

recurrence of rheumatic fever
valvular heart disease esp mitral stenosis
chronic heart failure