Acute Rheumatic Fever


Q1. Doctor, what exactly do you mean when you say that someone has got Acute Rheumatic Fever?

A1. Acute Rheumatic Fever is a disease which sometimes follows an attack of sore throat caused by a type of bacteria known as Group A Beta Hemolytic Streptococcus. The human body has a defense mechanism which tries to eliminate the invading bacteria. In subjects who are susceptible to this disease, the defense mechanism of the body attacks the patients’ body tissues such as the heart, joints, skin, and brain by mistake.

Q2. What did you mean when you said “by mistake”?

A2. Unfortunately, the structural proteins of the Streptococcus have similarities with the human body tissues. In people who are susceptible to Acute Rheumatic Fever, the immune system makes a mistake because of this similarity of proteins, and attacks the bacteria as well as its own tissues.

Q3. Is Acute Rheumatic Fever the same as Rheumatoid Arthritis?

A3. No, Rheumatoid Arthritis is a separate disease entity.

Q4. Which people who are susceptible to Acute Rheumatic Fever?

A4. Acute Rheumatic Fever is a disease which commonly affects the children and adolescents, although no age is exempt. It is more frequent in the low socio-economic strata because these subjects live in over-crowded houses. Over-crowding facilitates the spread of streptococcal infection from one person to another. Moreover, these subjects do not promptly go to a doctor for the prompt treatment of sore throat because of poverty and poor education.

Q5. What are the early cardiac manifestations of Acute Rheumatic Fever?

A5. Acute Rheumatic Fever may result in the dilatation of the heart. This is known to doctors as myocarditis, and commonly causes severe breathlessness. A few people die because of myocarditis.

Q6. What are the late cardiac manifestations of Rheumatic Fever?

A6. On or more heart valves may permanently become narrowed (=stenosis) or leaky (=regurgitation). The mitral valve is the most common cardiac valve to be involved, followed by the aortic valve, and the tricuspid valve. The following may occur singly, or in combination: mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, tricuspid stenosis, and tricuspid regurgitation. Treatment of these types of disease may sometimes involve major surgery of the heart valves, and can be very expensive.

Q7. What are the joint manifestations of Acute Rheumatic Fever?

A7. Acute Rheumatic Fever sometimes affects the joints. The large joints are involved. There may be pain, with or without swelling and warmth of the affected joints. The affected joints may become normal over a period of time. Sometimes, the same or new joints may be involved on a later date.

Q8. What are the brain manifestations of Rheumatic Fever?

A8. This is known as Sydenham’s chorea. It consists of multiple involuntary movements of the body. It occurs a few months after the attack of Acute Rheumatic Fever.

Q9. What are the skin manifestations of Acute Rheumatic Fever?

A9. There may be painless nodules over the elbows and knees. There can also be Erythema marginatum, which is a reddish rash with irregular margins and central clearing.

Q10. Do you diagnose Acute Rheumatic Fever on the basis of an elevated ASO titre?

A10. Acute Rheumatic Fever should be diagnosed on the basis of the Modified Jones Criteria, and not on the basis of an elevated ASO titre alone. The criteria are enumerated below:

Major Criteria:
  • Mono-arthritis or polyarthritis
  • Polyarthralgia
  • Chorea
  • Erythema marginatum
  • Subcutaneous nodules
Minor Criteria:
  • Monoarthralgia
  • Fever >= 38 degree C
  • ESR >= 30 mm/hr
  • CRP >= 3.0 mg/dl
  • Prolonged PR interval, after accounting for age variability

Supporting evidence of streptococcal infection during the past 45 days: elevated or rising anti-streptolysin O (ASO) or other anti-streptococcal antibody, or a positive throat culture, rapid antigen test for group A streptococci, or recent scarlet fever.

Q11. How do you prevent Acute Rheumatic Fever?

A11.

Primary prevention:

This can be done with the help of intra-muscular injections of Benzathine penicillin G, or oral Penicillin V. If the subject is allergic to penicillin, one can administer clindamycin, azithromycin, and clarithromycin.

Secondary prevention:

This can be done with the help of intra-muscular injections of Benzathine penicillin G, or oral Penicillin V. If the subject is allergic to penicillin, one can administer erythromycin.


Disclaimer

This article is written with the intention of arousing the interest of the members of the public in matters related to public health. It is not intended to be a substitute for expert medical advice. For all advice related to disease, please consult your healthcare-giver.