Skip to Main Content

++

  • Acute rheumatic fever

++

  • 390 Rheumatic fever without mention of heart involvement
  • 391 Rheumatic fever with heart involvement
  • 392 Rheumatic chorea

++

  • I00 Rheumatic fever without heart involvement
  • I01.0 Acute rheumatic pericarditis
  • I01.1 Acute rheumatic endocarditis
  • I01.2 Acute rheumatic myocarditis
  • I01.8 Other acute rheumatic heart disease
  • I01.9 Acute rheumatic heart disease, unspecified
  • I02.0 Rheumatic chorea with heart involvement
  • I02.9 Rheumatic chorea without heart involvement

++
++

Description

++

  • Autoimmune inflammatory disease that can develop as a sequela of streptococcal infection, group A
  • Characterized by inflammatory lesions of the joints, heart, blood vessels, subcutaneous tissue, and central nervous system
  • Form of endocarditis

++

Essentials of Diagnosis

++

  • Rheumatic fever has variable manifestations; therefore, no specific diagnostic test exists for diagnosis
  • Usually occurs approximately 20 days after strep throat or scarlet fever
  • Diagnosis is based on the Jones criteria; major and minor criteria used to confirm diagnosis
  • Diagnosed if individual meets two major criteria or one major and one minor crieteria with previous strep infection
    • Major criteria
      • Carditis
      • Polyarthritis
      • Sydenham chorea
      • Erythema marginatum
      • Subcutaneous nodules
    • Minor criteria
      • Polyrthralgia
      • Previous rheumatic fever or rheumatic heart disease
      • Fever
      • Elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels
      • Prolonged PR interval
  • Evidence of preceding group A streptococcal infection: positive throat culture or rapid antigen test result
  • Elevated or rising streptococcal antibody titer

++

General Considerations

++

  • The most significant complication is rheumatic heart disease, which usually occurs after repeated bouts of acute illness
    • It can present as valvular stenosis, most commonly involving the mitral valve
    • These patients are prone to infective endocarditis and stroke
  • Chorea can present months after the inciting infection
  • Some physicians monitor ESR and restart activity when it normalizes

++

Demographics

++

  • Rheumatic fever is predominantly a disease of developing countries and is concentrated in areas of deprivation and crowding.
  • The risk of developing rheumatic fever after an episode of streptococcal pharyngitis has been estimated at 0.3 to 3%.
  • Overall incidence in the United States is less than 1 per 100,000.
  • It is most common in 5- to 15-year-old children.
  • A genetic predisposition to rheumatic fever does exist.
  • The disease does not have a major racial or gender predisposition.

++

Signs and Symptoms

++

  • Signs and symptoms result from inflammation in the heart, joints, skin, or central nervous system.
  • Sore throat: 35% to 60% of patients with rheumatic fever recall having upper respiratory symptoms in the preceding several weeks.
  • Swollen and painful joints, particularly knees, ankles, elbows, and wrists
  • Erythema marginatum: flat or raised red lattice-like rash found on trunk and proximal ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.