Rheumatic fever

Question 1

Definition of Rheumatic fever

Answer 1

• Autoimmune disease following infection with group A ß-haemolytic strep (in susceptible individuals)

Question 2

Aetiology of Rheumatic fever

Answer 2

• Group A ß-haemolytic strep infection

Question 3

Epidemiology of Rheumatic fever

Answer 3

• Developing countries (rare in the developed world)
• Usually affects children aged 5 - 15 years

Question 4

Pathophysiology of Rheumatic fever

Answer 4

• Molecular mimicry between group A ß-haemolytic strep antigens and host tissue proteins
• Antibodies cross-react:
  
  • Cardiac
    
    • Mitral valve (stenosis)
  • Synovial
  • Neuronal
  • Dermal

Question 5

Clinical features of Rheumatic fever

Answer 5

• Symptoms
  
  • Fever
  • Polyarthritis (exquisitely painful)
    
    • Knees, ankles, elbows, wrists, hips
    • Migratory
    • Flitting (<1 week)
  • Recent pharyngeal infection (group A strep)
    
    • Sore throat
    • Scarlet fever
• Signs (Jones diagnostic criteria)

Question 6

Investigations for Rheumatic fever

Answer 6

• Bloods
  
  • Inflammatory markers (CRP, ESR)
  • Culture (exclude sepsis if febrile)
• ECG (prolonged PR)
• CXR
  
  • RVH + RA enlargement (MS)
  • CHF
• Echo
• (Throat swab)
  
  • Group A strep usually eradicated before onset of disease

Question 7

Management of Rheumatic fever

Answer 7

• Polyarthritis
  
  • Rest/immobilisation
  • Aspirin (high dose)
• Heart failure
  
  • Diuretic
    
    • Furosemide
  • ACE inhibitor
    
    • Enalopril
      *