Rheumatic Fever (cont.)
David Perlstein, MD, MBA, FAAP
Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- Rheumatic fever (acute rheumatic fever or ARF) facts
- What is rheumatic fever?
- What are the Jones criteria?
- What causes rheumatic fever?
- What are symptoms and signs of rheumatic fever?
- How is rheumatic fever diagnosed?
- How is rheumatic fever treated?
- What are the complications of rheumatic fever?
- How is rheumatic fever prevented?
- How common is rheumatic fever?
What are the Jones criteria?
Jones criteria are guidelines decided on by the American Heart Association to help doctors clinically diagnose rheumatic fever. Two major criteria or one major and two minor plus a history of a streptococcal throat infection are required to make the diagnosis of rheumatic fever.
The major criteria for diagnosis include
- arthritis in several joints (polyarthritis),
- heart inflammation (carditis),
- nodules under the skin (subcutaneous nodules or Aschoff bodies),
- rapid, jerky movements (Sydenham's chorea), and
- skin rash (erythema marginatum).
The minor criteria include
- high ESR (erythrocyte sedimentation rate, an laboratory sign of inflammation),
- joint pain (arthralgia),
- EKG changes (electrocardiogram), and
- other laboratory findings (elevated c-reactive protein, elevated or rising streptococcal antigen test).
What causes rheumatic fever?
There is a direct and well described connection between certain streptococcal infections and rheumatic fever. Most commonly, rheumatic fever is preceded by a throat infection with group A beta-hemolytic Streptococcus (strep throat, GABHS, or GAS). The bacterium causes an autoimmune (antibodies that attack the host's own cells) inflammatory response in some people which leads to the myriad of signs and symptoms described by the Jones criteria. Streptococcal throat infections are contagious, but rheumatic fever is not. The symptoms of rheumatic fever generally develop within two to three weeks of an infection with streptococcal bacteria, and usually the first symptoms are painful joints or arthritis.
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