Rheumatic fever

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 13 Dec 2025

最后更新： 10 Apr 2024

Acute rheumatic fever (ARF) continues to cause a large burden of mortality and morbidity in low- and middle-income countries. It is less common in high-income countries, but continues to be seen in indigenous communities and during outbreaks.

Currently, no single test can diagnose ARF. Diagnosis is clinical and relies on the Jones criteria.

The 5 major manifestations of ARF are carditis, arthritis, chorea, erythema marginatum, and subcutaneous nodules, of which the most common are carditis and arthritis.

The Jones criteria were revised in 2015 to include separate criteria for low-risk and moderate- to high-risk populations and introduce the use of Doppler echocardiography to diagnose subclinical carditis.

While all other manifestations of ARF resolve without sequelae, carditis can lead to chronic rheumatic heart disease (RHD).

Secondary prophylaxis is thought to ameliorate the progression of ARF to chronic RHD, but even the mildest forms of carditis can result in chronic RHD and decreased survival.

The prognosis of established rheumatic valvular disease remains guarded, especially with severe disease.

定义

Acute rheumatic fever (ARF) is an autoimmune disease that mostly occurs following group A streptococcal throat infection, although there is growing evidence of ARF following skin infection in certain regions of the world. It can affect multiple systems, including the joints, heart, brain, and skin. Only the effects on the heart can lead to permanent illness; chronic changes to the heart valves are referred to as chronic rheumatic heart disease (RHD). Without long-term penicillin secondary prophylaxis, ARF can recur, leading to cumulative damage to the cardiac valvular tissue.

病史和体格检查

关键诊断因素

fever
joint pain

完整详情

其他诊断因素

recent sore throat or scarlet fever
recent skin infection
chest pain
shortness of breath
palpitations
heart murmur
pericardial rub
signs of cardiac failure
swollen joints
restlessness
clumsiness
emotional lability and personality changes
jerky, uncoordinated choreiform movements
inability to maintain protrusion of the tongue
milkmaid's grip
spooning sign
pronator sign
erythema marginatum
subcutaneous nodules
pregnancy or taking oral contraceptive pill

完整详情

危险因素

poverty
overcrowded living quarters
family history of rheumatic fever
HLA association
genetic susceptibility
indigenous populations; Aboriginal Australian, Asian, and Pacific Islanders
D8/17 B cell antigen positivity

完整详情

诊断性检查

首要检查

erythrocyte sedimentation rate (ESR)
CRP
WBC count
blood cultures
electrocardiogram
chest x-ray
echocardiogram
throat culture
rapid antigen test for group A streptococci
anti-streptococcal serology
rapid molecular test

完整详情

治疗流程

初步治疗

monoarthritis in unconfirmed rheumatic fever

急症处理

possible rheumatic fever

confirmed rheumatic fever

持续性治疗

all patients following acute treatment

撰稿人

作者

Liesl Zühlke, MBChB DCH FCPaeds Cert Card (Paeds) MPH FACC FESC MSc PhD

Vice-President South African Medical Research Council - Extramural Research and Internal Portfolio

Director Children's Heart Disease Research Unit

Paediatric Cardiologist, Division of Paediatric Cardiology, Department of Paediatrics

Red Cross Children's Hospital

Cape Heart Institute and Institute of Infectious Diseases and Molecular Medicine

Faculty of Health Sciences

University of Cape Town

Cape Town

South Africa

利益声明

LZ has been funded by the South African Medical Research Council, NRF, and through the African Research Leader award jointly by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement. LZ is a board member of the World Heart Federation, the NCD Alliance, and FoodForward South Africa. LZ an author of the UpToDate rheumatic heart disease topic. None of the above are competing interests.

John Lawrenson, null

Head of Clinical Unit

Paediatric Cardiology Service of the Western Cape

Red Cross Children's and Tygerberg Hospital

Stellenbosch University and University of Cape Town

Cape Town

South Africa

გაფრთხილება:

JL declares that he has no competing interests.

მადლიერება

Professor Liesl Zühlke and Professor John Lawrenson would like to gratefully acknowledge Dr Rachel Webb, Dr Andrew C. Steer, and Dr Jonathan Carapetis, previous contributors to this topic.

გაფრთხილება:

RW declares that she has no competing interests; she is an active researcher and clinician in acute rheumatic fever/rheumatic heart disease and is a co-investigator on a (non-industry) grant funded by the Health Research Council of New Zealand and gives educational talks and has prepared manuscripts on rheumatic fever solely in capacity as a University of Auckland academic and Paediatric Infectious Diseases Specialist. ACS and JC declare that they have no competing interests.

რეცენზენტები

Salah Zaher, MD

Professor of Pediatrics

Division of Pediatric Cardiology

Faculty of Medicine

University of Alexandria

Cardiologist

El Shatby Children's Hospital

Alexandria

Egypt

გაფრთხილება:

SZ declares that she has no competing interests.

Nigel Wilson, FRACP

Paediatric Cardiologist/Interventional Cardiologist

Paediatric and Congenital Cardiac Services

Green Lane Clinical Services

Starship Children's Hospital

Auckland

New Zealand

გაფრთხილება:

NW declares that he has no competing interests.

Andrea Summer, MD

Assistant Professor of Pediatrics

Medical University of South Carolina

Charleston

გაფრთხილება:

AS declares that she has no competing interests.

რეცენზენტების განცხადებები

BMJ Best Practice-ის თემების განახლება სხვადასხვა პერიოდულობით ხდება მტკიცებულებებისა და რეკომენდაციების განვითარების შესაბამისად. ქვემოთ ჩამოთვლილმა რეცენზენტებმა თემის არსებობის მანძილზე კონტენტს ერთხელ მაინც გადახედეს.

გაფრთხილება

რეცენზენტების აფილიაციები და გაფრთხილებები მოცემულია გადახედვის მომენტისთვის.

წყაროები

ჩვენი მტკიცებულებებისა და სარედაქციო ჯგუფები თანამშრომლობენ საერთაშორისო ექსპერტებსა და რეცენზენტებთან, რათა უზრუნველვყოთ თქვენი წვდომა კლინიკურად ყველაზე მნიშვნელოვან ინფორმაციაზე.

ძირითადი სტატიები

World Health Organization. Rheumatic fever and rheumatic heart disease: report of a WHO Expert Consultation. 2004 [internet publication].სრული ტექსტი

Gewitz MH, Baltimore RS, Tani LY, et al. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation. 2015 May 19;131(20):1806-18.სრული ტექსტი აბსტრაქტი

Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers. 2016 Jan 14;2:15084.სრული ტექსტი აბსტრაქტი

Denny F, Wannamaker LW, Brink WR, et al. Prevention of rheumatic fever; treatment of preceding streptococci infection. J Am Med Assoc. 1950 May 13;143(2):151-3. აბსტრაქტი

Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009 Mar 24;119(11):1541-51.სრული ტექსტი აბსტრაქტი

RHDAustralia (ARF/RHD writing group). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3.2 edition, March 2022). 2022 [internet publication].სრული ტექსტი

Heart Foundation of New Zealand. New Zealand guidelines for rheumatic fever: diagnosis, management and secondary prevention of acute rheumatic fever and rheumatic heart disease: 2014 update. 2014 [internet publication].სრული ტექსტი

Manyemba J, Mayosi BM. Penicillin for secondary prevention of rheumatic fever. Cochrane Database Syst Rev. 2002;(3):CD002227.სრული ტექსტი აბსტრაქტი

გამოყენებული სტატიები

ამ თემაში მოხსენიებული წყაროების სრული სია ხელმისაწვდომია მომხმარებლებისთვის, რომლებსაც აქვთ წვდომა BMJ Best Practice-ის ყველა ნაწილზე.

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მეტი დიფერენციული დიაგნოზები
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- Recommendations for the use of echocardiography in the evaluation of rheumatic heart disease: a report from the American Society of Echocardiography
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მეტი გაიდლაინები
პაციენტის ბროშურები
Rheumatic fever
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Rheumatic fever

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

治疗流程

monoarthritis in unconfirmed rheumatic fever

possible rheumatic fever

confirmed rheumatic fever

all patients following acute treatment

撰稿人

作者

Liesl Zühlke, MBChB DCH FCPaeds Cert Card (Paeds) MPH FACC FESC MSc PhD

利益声明

John Lawrenson, null

გაფრთხილება:

მადლიერება

გაფრთხილება:

რეცენზენტები

Salah Zaher, MD

გაფრთხილება:

Nigel Wilson, FRACP

გაფრთხილება:

Andrea Summer, MD

გაფრთხილება:

რეცენზენტების განცხადებები

გაფრთხილება

წყაროები

ძირითადი სტატიები

გამოყენებული სტატიები

დიფერენციული დიაგნოზები

გაიდლაინები

პაციენტის ბროშურები

Videos

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

შედით სისტემაში BMJ Best Practice-ის მასალებზე სრული წვდომისთვის