Rheumatic fever

Acute rheumatic fever continues to cause a large burden of mortality and morbidity in developing countries. It is less common in developed countries but continues to be seen in indigenous communities and during outbreaks.

No single test can diagnose acute rheumatic fever. Diagnosis is clinical and relies on the Jones criteria.

The 5 major manifestations of acute rheumatic fever 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.

While all other manifestations of acute rheumatic fever resolve without sequelae, carditis can lead to chronic rheumatic heart disease.

No treatment has been shown to alter the progression of acute rheumatic fever to chronic rheumatic heart disease.

Secondary prophylaxis can improve the prognosis of established rheumatic valvular disease.

Acute rheumatic fever is an autoimmune disease that may occur following group A streptococcal throat infection. 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. Without long-term penicillin secondary prophylaxis, acute rheumatic fever can recur, leading to cumulative damage to the cardiac valvular tissue.