Rheumatic fever is an inflammatory disease that occurs following a kind bacterial infection (GroupA), such as sore throat or scarlet fever. It is believed to be caused by antibody cross-reactivity to heart, joints, skin and brain. The illness typically develops 2-3 weeks after the bacterial infection. Acute rheumatic fever commonly affects children between 5 to 15 years of age, with only 20% occurring in adults. It is quite similar in clinical presentation to Rheumatism (Bai in layman’s language), hence named rheumatic fever. But has nothing to do with Rheumatoid arthritis (RA). RA is an erosive and deforming disease for joints but rheumatic fever does not cause erosive joint disease.
What are Major and Minor Jones Criteria and how are they related to Rhuematic Fever?
A firm diagnosis of Rhuematic Fever requires the presence of two major or one major and two minor criteria. Also, the evidence of a recent streptococcal infection must be present. I’m going to list the criteria below as requested on the facebook page.
- Carditis: All layers of cardiac tissue are affected (pericardium, epicardium, myocardium, endocardium). The patient may have a new or changing murmur, with regurgitation being the most common followed by aortic insufficiency.
- Polyarthritis: Migrating arthritis that typically affects the major joints like knees, ankles, elbows and wrists. The joints are very painful and symptoms are very responsive to anti-inflammatory medicines like asprin.
- Chorea: Also known as Syndenham´s chorea, or “St. Vitus´ dance”. There are abrupt, purposeless movements in this condition. This may be the only manifestation of Acute rheumatic fever and its presence is diagnostic. It may also include emotional disturbances and inappropriate behavior.
- Erythema marginatum: A non-pruritic rash that commonly affects the trunk and proximal extremities, but spares the face. The rash typically migrates from central areas to periphery, and has well-defined borders.
- Subcutaneous nodules: Usually located over bones or tendons, these nodules are painless and firm.
- Arthralgia (only pain in the joints, no swelling)
- Previous rheumatic fever or rheumatic heart disease
- Acute phase reactants (these substances are manufactured by the body to fight against the invading organism): Leukocytosis, elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
- Prolonged P-R interval on electrocardiogram (ECG)
Evidence of preceding streptococcal infection: Any one of the following is considered adequate evidence of infection:
- Increased antistreptolysin O or other streptococcal antibodies
- Positive throat culture for Group A beta-hemolytic streptococci
- Positive rapid direct Group A strep carbohydrate antigen test
- Recent scarlet fever