Rheumatology

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Update on acute rheumatic fever: It still exists in remote communities
Canadian Family Physician, 05/18/09

Madden S et al. - This review article was prompted by 5 unrelated cases seen over 36 months in the author's regional community hospital. The author hope that it will remind physicians working in remote areas that ARF remains a part of our clinical vocabulary.

• Although acute rheumatic fever (ARF) is relatively rare in developed economies, it is much more common in the developing world and among aboriginal populations. Higher rates of ARF might be related to overcrowded and poor living conditions.
• Diagnosis requires 2 major, or 1 major and 2 minor, Jones criteria, as well as evidence of previous streptococcal infection. Major criteria include carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules; minor criteria include fever, arthralgia, previous ARF or rheumatic heart disease, acute-phase reactants, and prolonged PR interval on electrocardiogram.
• Most cases of ARF can be prevented with antibiotic treatment received within 9 days of group A streptococcal pharyngitis. After onset of ARF there is no effective treatment for the immune reaction. Salicylates provide relief from fever and arthritis, prednisone can be used for patients who experience chorea, and carditis is addressed with bed rest. Secondary prophylaxis to prevent recurrence is warranted for all patients.

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