4 Interesting Facts of Acute Rheumatic Fever
1. Acute rheumatic fever (ARF) causes a migratory polyarthritis, most typically in children, and is the most common cause of acquired valvular heart disease worldwide.
2. Diagnosis of ARF is typically made by Jones criteria, which were updated in 2015 to account for population risk and echocardiographic diagnosis of rheumatic heart disease (RHD).
3. Salicylates and antibiotics (ideally with beta-lactams and penicillin in particular) are the mainstays of acute treatment of ARF, with long-term antibiotic prophylaxis regimens of varying lengths indicated thereafter.
4. ARF is described as the prototypical disease of molecular mimicry, although a complex range of host factors and characteristics of group A streptococcus (GAS) may contribute to pathogenesis.
Acute Rheumatic Fever is a systemic inflammatory syndrome occurring in a subset of patients (1%–6%) infected with GAS, most commonly in the setting of pharyngitis. ARF presents 2 to 4 weeks following primary infection with a migratory arthritis and carditis, with chorea, subcutaneous nodules, and erythema marginatum (EM) also seen. While acute musculoskeletal symptoms are sometimes dramatic, subclinical and clinical RHD represents the most clinically devastating manifestation of the illness and is the most common cause of acquired valvular disease worldwide.
