Acute rheumatic fever is an autoimmune disease that can occur after a streptococcal throat infection. It commonly affects children ages 5-14 and causes arthritis, carditis, chorea, and skin manifestations. If not properly treated, it can lead to rheumatic heart disease, which is the most common cause of acquired valvular heart disease in developing countries. Treatment involves antibiotics to prevent recurrence, as well as medications for symptoms like arthritis, heart failure, and chorea. Strict adherence to secondary prevention protocols using long-term antibiotics can decrease the severity and progression of rheumatic heart disease by 50-70%.
4. • Multi system disease
• Autoimmune reaction to streptococcal A infection.
• Almost all the manifestations resolve completely.
• Disease of poverty
• M/c age group -5-14 years of age.
• Males= Females.
• Recurrent episodes are more common in young adulta and older
individuals.
• Prevalence of RHD peaks at 25-40 years of age.
• Females> males.
5.
6. • Group A streptococcal serotypes M- 1,2,4,3,5,6,12,18,24.
• Antibodies to M protein and N-Acetyl glusosamine of GAS.
GENETIC:
Increased susceptibility – HLA-DR7,DR4.
7.
8.
9. Clinical features:
• Most common cause of acquired valvular heart disease in developing
countries.
• Latent period of 3 weeks(4-5 weeks) except for chorea and indolent
carditis
• M/C clinical features are:
• polyarthritis(60-75%) and carditis(50-60%)
• Chorea-<2-30%.
• Erythemia marginatum and subcutaneous nodules are rare <5%.
16. TREATMENT
• SUPPORTIVE
• DIURETICS for heart failure.
• If refractory heart failure-trial of steroids and surgery if steroids also
refractory
17. ARTHRITIS:
• Assymmetrical migratory polyarthritis –n0n erosive with no deformity.
• Duration-<4 weeks.
• Knee,elbow,hip,ankle
• Arthralgia
• Aseptic monoarthritis
• Highly responsive to nsaids,salicylates
18.
19. CHOREA:
• SYDENHAMS CHOREA:
• Human monoclonal antibodies target gangliosides and target the dopamine
receptors on the surface of the neuron.
• m/c IN FEMALES
• M/C IN head and upper limbs with scooping action.
• Can be isolated as latency is more and other movements have subsided.
• Hypotonia with motor impersistence.(sustained muscle contraction not
maintained)
• ”JACK IN THE BOX”
• MILK MAID GRIP
• Disappear during sleep
• Most common associated with carditis.
20.
21. TREATMENT:
• Milder cases- Sedation.
• SEVERE CASES- carbamezapine , sodium valproate.
• SEVERE AND REFRACTORY:
CORTICOSTEROIDS,IVIG(as antibody are responsible)
22. SKIN MANIFESTATIONS:
• Erthema Marginatum-
• MOST SPECIFIC.<10%
• Begins as NON –PRURITIC pink macules –clears centrally-serpigenous
edges.
• Evanescent –Spreads very fast and more prominent after a hot
shower.
• Usually associated with carditis.
• Trunk and limbs more common.Never in the face.
23. • SUBCUTANEOUS NODULE:’
M/C SITE: Occiput,elbows,knees and Achilles tendon.
Firm,painless and easily movable 0.5-2 cms.
24. REVISED JONES CRITERIA
• LOW RISK
• <2/100000 SCHOOL GOING
CHILDREN
• INCIDE<1/1000 RHD IN ALL AGE
POPULATION
• HIGH RISK
27. ESSENTIAL CRITERIA:
• Evidence of recent GAS Throat infection-
• POSITIVE THROAT CULTURE.
• Elevated ASO TITRE ->255 IN Adults.
• Elevated Anti-DNAse.
• CRITERIA FOR DIAGNOSIS:
FIRST EPISODE OF ARF- 2 MAJOR ( OR) 2 MAJOR+1 MINOR.
RECURRENT EPISODE- 2 MAJOR
(OR)
2 MAJOR +1 MINOR
( OR)
3 MINOR
28. PRIMARY PROPHYLAXIS:
• ARF_ NO CARDITIS
• Antibiotics should be initiated within 9 days of ARF to prevent
progression into carditis.
