Acute Rheumatic Fever
Features suggestive of Acute Rheumatic Fever include:
- Joint pain, swelling and warmth primarily affecting large joints, particularly knees, ankles, wrists and elbows.
- Usually initially one joint is affected and then migratory (moves to affect other joints) and additive (becomes many joints affected). A monoarthritis pattern is also possible albeit less common than polyarthritis. Joint pain is prominent, occurs at rest and is increased by movement.
- Associated manifestations may include fever, arthralgia (if not arthritis), carditis (signs ranging from tachycardia at rest, prolonged PR interval, new murmur suggesting mitral and/or aortic insufficiency to acute heart failure), erythema marginatum (non-pruritic, macular, serpiginous rash with erythematous border especially on trunk and upper, inner aspects of limbs), chorea (usually symmetric persistent, involuntary and purposeless movements of extremities) or subcutaneous nodules (extensor surfaces).
- Diagnosis is made by using the Jones criteria - these have been revised in 2015 (see Further Reading) with major and minor criteria.
- Evidence of streptococcal infection (streptococcal serology or throat swab positive for group A streptococcus)
- Acute rheumatic fever is discussed further in the modules - Investigation, Limp and Arthritis.
Further Information:
Guidance to aid diagnosis, prevention and management of rheumatic fever and rheumatic heart disease.
https://starship.org.nz/guidelines/rheumatic-fever-children-and-adults.
