Major manifestations of rheumatic fever

Major manifestations of rheumatic fever

Major manifestations of rheumatic fever:

1. Polyarthritis – usually migratory, fleeting and flitting type of arthritis; fleeting means transient; flitting means jumping from one joint to another
2. Carditis – though it is a pancarditis, predominant manifestation is valvular regurgitation
3. Chorea – Sydenham’s chorea. Chorea being a late manifestation, is seldom associated with arthritis, which is an early manifestation. (Imagine the trouble for a patient with acute arthritis and chorea!).
4. Erythema marginatum
5. Subcutaneous nodules – usually seen over the extensor aspect, around the the elbow, knee and over the scalp. Subcutaneous nodules are usually associated with carditis – nodules under the skin, nodules in the heart (Aschoff nodules – a pathological finding in rheumatic fever). Subcutaneous nodules in rheumatic fever are painless and freely mobile.

Rheumatic fever diagnosis is based on the Jones criteria which were developed in 1944. It has been revised twice by the American Heart Association (AHA), in 1992 and recently in 2015. In the latest revision, major criteria has been supplemented by echocardiography to include a concept of subclinical carditis which was not there in earlier versions [1, 2]. It is now well known that subclinical carditis manifest on echocardiography precedes clinical carditis.

It is interesting to note that rheumatic fever was first described in London in 1898 by William Cheadle [1].

Reference

1. Izabela Szczygielska, Elżbieta Hernik, Beata Kołodziejczyk, Agnieszka Gazda, Maria Maślińska, Piotr Gietka. Rheumatic Fever – New Diagnostic Criteria. Reumatologia. 2018;56(1):37-41.
2. Michael H Gewitz, Robert S Baltimore, Lloyd Y Tani, Craig A Sable, Stanford T Shulman, Jonathan Carapetis, Bo Remenyi, Kathryn A Taubert, Ann F Bolger, Lee Beerman, Bongani M Mayosi, Andrea Beaton, Natesa G Pandian, Edward L Kaplan, American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young. Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography: A Scientific Statement From the American Heart Association. Circulation. 2015 May 19;131(20):1806-18.