Rheumatic Fever Pathophysiology

Study Notes

Rheumatic fever is an inflammatory disease that occurs as a result of an autoimmune response to a group A streptococcal (GAS) infection.
The immune system mistakenly attacks the body's own tissues, particularly the heart, joints, and skin.
The inflammatory response leads to the activation of various immune cells, such as T cells and macrophages, which release cytokines and chemokines that cause tissue damage.
The heart valves are commonly affected, leading to valvulitis and subsequent scarring.

Diagnosis is based on a combination of clinical features, laboratory tests, and echocardiography.
Jones Criteria are used to diagnose acute rheumatic fever (ARF) and are divided into major and minor criteria.
Major criteria:
- Carditis
- Arthritis
- Chorea
- Erythema marginatum
- Subcutaneous nodules
Minor criteria:
- Fever
- Arthralgia
- Elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
- Prolonged PR interval on electrocardiogram (ECG)

Rheumatic heart disease (RHD): the most common complication, resulting in scarring of the heart valves and potentially leading to heart failure.
Heart valve damage: can lead to mitral regurgitation, mitral stenosis, aortic regurgitation, or aortic stenosis.
Increased risk of endocarditis: due to the damaged heart valves.
Recurrent episodes of ARF: can lead to further heart damage and increased risk of complications.

Primary prevention: treating GAS infections with antibiotics to prevent ARF.
Secondary prevention: regular antibiotic prophylaxis to prevent recurrent episodes of ARF.
Treatment of ARF:
- Anti-inflammatory medications (e.g., aspirin, corticosteroids) to reduce inflammation and relieve symptoms.
- Antibiotics to eradicate any remaining GAS infection.
- Bed rest and supportive care.

Developed by T. Duckett Jones in 1944 to diagnose acute rheumatic fever (ARF).
Major criteria:
- Carditis (inflammation of the heart)
- Arthritis (inflammation of the joints)
- Chorea (involuntary movements)
- Erythema marginatum (a characteristic rash)
- Subcutaneous nodules (small, painless bumps under the skin)
Minor criteria:
- Fever
- Arthralgia (joint pain)
- Elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
- Prolonged PR interval on electrocardiogram (ECG)
Diagnosis of ARF requires:
- Two major criteria
- One major criterion and two minor criteria
- Three minor criteria

Rheumatic fever is an inflammatory disease caused by an autoimmune response to group A streptococcal (GAS) infection, leading to mistaken attacks on the body's own tissues, especially the heart, joints, and skin.
The inflammatory response activates immune cells, releasing cytokines and chemokines that cause tissue damage.
Heart valves are commonly affected, leading to valvulitis and scarring.

Diagnosis is based on clinical features, laboratory tests, and echocardiography.
Jones Criteria are used to diagnose acute rheumatic fever (ARF), divided into major and minor criteria.
Major criteria include carditis, arthritis, chorea, erythema marginatum, and subcutaneous nodules.
Minor criteria include fever, arthralgia, elevated ESR or CRP, and prolonged PR interval on ECG.

Rheumatic heart disease (RHD) is the most common complication, resulting in scarring of heart valves and potentially leading to heart failure.
Heart valve damage can lead to mitral regurgitation, mitral stenosis, aortic regurgitation, or aortic stenosis.
There is an increased risk of endocarditis due to damaged heart valves.
Recurrent episodes of ARF can lead to further heart damage and increased risk of complications.

Primary prevention involves treating GAS infections with antibiotics to prevent ARF.
Secondary prevention involves regular antibiotic prophylaxis to prevent recurrent episodes of ARF.
Treatment of ARF includes anti-inflammatory medications, antibiotics, bed rest, and supportive care.

Developed by T. Duckett Jones in 1944 to diagnose acute rheumatic fever (ARF).
Jones Criteria require two major criteria, one major criterion and two minor criteria, or three minor criteria for diagnosis.