Erythema marginatum —evanescent, pink or faintly red, non-pruritic rashinvolving the trunk and sometimes the limbs.The outer edge of the lesion is sharp; the inner edgeis diffuse. The lesion is also known as "erythema annulare“ since the margin of the lesion isusually continuous, making a ring.
Subcutaneous nodules —• firm, painless lesions ranging from afew millimeters to 2 cm in size.•located over a bony surface or prominenceor near tendons (usually extensor surfaces) and are usually symmetric.•The overlying skin is not inflamed andusually can be moved over the nodules The number of nodules varies from asingle lesion to a few dozen; the average number is three or four.
Sydenham chorea —chorea minor or "St. Vitus dance"abrupt, nonrhythmic involuntary movements,muscular weakness, and emotional disturbances.The movements frequently are more marked onone side, are occasionally unilateral (hemichorea), and cease during sleep.Muscle weakness is best demonstrated by askingthe patient to squeeze the examiners hands.The pressure of the patients grip increases anddecreases capriciously, a phenomenon known as relapsing grip or "milk maids sign.“.
Carditis —pancarditis, affecting the pericardium, epicardium,myocardium, and endocardium.mild to moderate chest discomfort and pleuriticchest pain.Physical examination may demonstrate new orchanging murmurs;mitral regurgitation is the most common earlyvalvular manifestation.Pericardial friction rub is indicative of pericarditis.Severe valvular damage together with myocardial dysfunction due to myocarditis can leadto heart failure.Ecg findings may demonstrate any degree of heart block, including atrioventriculardissociation.Chest radiography may demonstrate cardiomegaly.
Arthritis —The knees, ankles, elbows, and wrists are affected most commonlyThe onset of arthritis in different joints usually overlaps, giving the appearance that thedisease "migrates" from joint to joint.Onset and resolution of arthritis may be rapid (within 1 to 2 days) and the arthritis may besevere enough to severely limit movement.Analysis of the synovial fluid in rheumatic fever with arthritis generally demonstratessterile inflammatory fluid.
Treatment and prevention• There is no therapy that slows progression of valvular damage in the setting of Acute Rheumatic Fever (ARF). There are three major goals of treatment:• Symptomatic relief of acute disease manifestations• Eradication of the group A beta-hemolytic streptococcus (GAS)• Prophylaxis against future GAS infection to prevent recurrent cardiac disease
TREATMENT —• Antibiotic therapy — Patients with acute rheumatic fever should be initiated on antibiotic therapy to eradicate GAS carriage. – management of streptococcal pharyngitis, – throat cultures performed,if positive a full course of antibiotic therapy• Carditis — Patients with severe carditis (significant cardiomegaly, congestive heart failure, and/or third-degree heart block) should be treated with conventional therapy for heart failure.• Valve surgery may be necessary when heart failure due to regurgitant lesions cannot be managed with medical therapy alone.• Aspirin (80 to 100 mg/kg per day in children and 4 to 8 g/day in adults) is the major anti-inflammatory agent for relief of symptoms due to acute rheumatic fever.• Arthritis and rash — Aspirin (80 to 100 mg/kg per day in children and 4 to 8 g/day in adults) is helpful for reducing discomfort related to arthritis and fever.