HEALTH - RHEUMATIC FEVERRheumatic fever (acute rheumatic fever or ARF) is an autoimmune disease that may occur after a group A streptococcal throat infection that causes inflammatory lesions in connective tissue, especially that of the heart, joints, blood vessels, and subcutaneous tissue. The disease has been described since the 1500s, but the association between a throat infection and rheumatic fever symptom development was not described until the 1880s. It was associated with scarlet fever in the 1900s. Prior to the broad availability of penicillin, rheumatic fever was a leading cause of death in children and one of the leading causes of acquired heart disease in adults. The disease has many symptoms and can affect different parts of the body, including the heart, joints, skin, and brain. There is no simple diagnostic test for rheumatic fever, so the American Heart Association's modified Jones criteria (first published in 1944 and listed below) are used to assist the physician in making the proper diagnosis.
Symptoms
Fever
Painful and tender joints most often the ankles, knees, elbows or wrists; less often the shoulders, hips, hands and feet.
Pain in one joint that migrates to another joint
Red, hot or swollen joints
Small, painless nodules beneath the skin
Chest pain
Sensation of rapid, fluttering or pounding heartbeats
Fatigue
Shortness of breath
Flat or slightly raised, painless rash with a ragged edge
Jerky, uncontrollable body movements most often in the hands, feet and face
Outbursts of unusual behavior, such as crying or inappropriate laughing, that accompanies Sydenham chorea.
Treatment
There is no cure for rheumatic fever once it has developed, although medications can be used to eradicate any remaining streptococcal infection and to control some of the symptoms. Treatment consists of antibiotics, usually penicillin, bed rest, and aspirin or steroids. Aspirin may reduce fever, and relieve joint pain and swelling. Corticosteroids may be used if aspirin is inadequate. Fortunately, recurrent streptococcal infections can be prevented very effectively with penicillin (Erythromycin may be substituted). To prevent recurrent rheumatic fever in persons who have already had one episode, monthly injections of a long-lasting preparation of penicillin can be effective. The risk of recurrence is higher in patients in whom the cardiac manifestations of acute rheumatic fever do not resolve, and those patients should receive antibiotic prophylaxis (protection) prior to dental or surgical procedures. More Information
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