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54: RHEUMATIC FEVER

Shari Rone-Adams, DBA, MHSA, PT

CONDITION/DISORDER SYNONYM

  • Acute rheumatic fever

ICD-9-CM CODES

  • 390 Rheumatic fever without mention of heart involvement

  • 391 Rheumatic fever with heart involvement

  • 392 Rheumatic chorea

ICD-10-CM CODES

  • 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

PREFERRED PRACTICE PATTERNS1

  • 4C: Impaired Muscle Performance

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

  • 6D: Impaired Aerobic Capacity/Endurance Associated with Cardiovascular Pump Dysfunction or Failure

  • 6E: Impaired Ventilation and Respiration/Gas Exchange Associated with Ventilatory Pump Dysfunction or Failure

PATIENT PRESENTATION

A 9-year-old female presents with joint pain and swelling. Three days ago the left knee was the most painful but on the day the left knee is better, but increased pain and swelling is present in the right ankle. The right ankle is swollen, tender and very warm to the touch. Mother reports a low-grade fever over the past week. The client reports that she has been very tired and was unable to participate in PE as they were running laps and she was short of breath. She also reports shortness of breath when lying down at night.

KEY FEATURES

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 criteria with previous strep infection

    • Major criteria

      • Carditis

      • Polyarthritis

      • Sydenham chorea (SC)

      • Erythema marginatum

      • Subcutaneous nodules

    • Minor criteria

      • Polyarthralgia

      • 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

FIGURE 54-1

Erythema marginatum of rheumatic fever. Enlarging and shifting transient annular and polycyclic lesions. (From Goldsmith LA, Katz SI, Gilchrest BA, Paller A, Leffell DJ, Wolff K. Fitzpatrick’s Dermatology in General Medicine. 8th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • The most significant complication is ...

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