Rheumatic Fever Overview and Assessment

Rheumatic Fever: Overview

• Rheumatic fever is an inflammatory disease primarily affecting joints and heart, with less frequent involvement of nervous system, skin, and subcutaneous tissues.
• It's a complication of Group A β-hemolytic streptococcal (GABHS) upper respiratory tract infection.

Assessment Criteria

Major Criteria

• Carditis: Inflammation of the heart, most commonly affecting mitral and aortic valves.
• Polyarthritis (migratory): Joint inflammation affecting multiple joints, appearing and disappearing over time. Joints like knees, hips, shoulders, wrists, and elbows are commonly affected. Symptoms include swelling, redness, heat, and pain. This happens in the first few weeks after a fever.
• Chorea: Neurological disorder causing involuntary, irregular, sudden movements of extremities and facial grimaces. Emotional instability, speech disturbances, and significant muscle weakness are associated symptoms. Anxiety could worsen chorea.
• Erythema marginatum: Non-itchy skin rash, presenting as undifferentiated macules on the torso and inner extremities.
• Subcutaneous nodules: Small, firm, painless nodules under the skin (0.5-1cm). They are often found on extensor surfaces of joints and can be found on knees, elbows, ankles, and scalp.

Minor Criteria

• Fever: Body temperature of 38-39°C.
• Arthralgia (joint pain): Pain in a joint without inflammation.
• Unexplained Epistaxis (nosebleed): Abnormal nosebleeds
• Abdominal pain.
• Weakness, fatigue, anorexia (loss of appetite), pallor (paleness), and weight loss.

Rheumatic Carditis

• Mitral and aortic valves are predominantly affected.

Rheumatic Arthritis

• Affects more than one joint in the first one to two weeks of fever.
• Characterized by joint swelling, redness, heat, and pain.

Rheumatic Chorea

• Affects the central nervous system, causing involuntary movements of extremities and facial grimaces.
• Involves emotional instability, speech problems, and severe muscle weakness.

Subcutaneous Nodules

• Associated with severe carditis or recurrent rheumatic fever.
• Small, firm, painless nodules (0.5-1 cm) that don't adhere to the skin.

Erythema Marginatum

• Non-itchy skin rash (undifferentiated macules) appears on the trunk and inner aspects of extremities.

Diagnostic Procedures

• Two major criteria or one major and two minor criteria plus evidence of preceding GABHS infection.
• Elevated antistreptolysin-O (ASO) titers (abnormal values exceeding 400 IU/mL). Normal is 200-400.
• Elevated erythrocyte sedimentation rate (ESR)
• Elevated C-reactive protein (CRP)
• Electrocardiogram (ECG)
• X-rays (Radiographs)

Explore the significant aspects of rheumatic fever, including its effects on the heart, joints, and nervous system. This quiz covers the major assessment criteria, such as carditis, polyarthritis, and chorea. Test your knowledge on this inflammatory disease and its complications.