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Rheumatic Fever
- Significant cause of cardiovascular morbidity in developing countries and still present in the USA, although declining in incidence.
- American Heart Association update of the Jones Criteria (1992):
- Major Criteria
(1) Carditis (of any of the layers of the heart)
(2) Polyarthritis
(3) Subcutaneous Nodules
(4) Erythema Marginatum
(5) Chorea - Minor Criteria
(1) Arthralgia (not a criterion if polyarthritis is present)
(2) Fever
(3) Elevated acute-phase reactants (ESR, CRP)
(4) Prolonged P-R interval
- Major Criteria
- Diagnosis made by presence of TWO MAJOR or ONE MAJOR PLUS TWO MINOR.
- Diagnosis can also be made with presence of chorea and documented strep pharyngitis.
- Acute Management
- Treat the Infection
(1) Penicillin (Pen V for 10 days or Pen G IM) - Alleviate Symptoms
(1) Salicylates are particularly effective for migratory arthritis
(2) High Dose ASA (80-100mg/kg/Day for several weeks, and then taper)
(3) NSAIDs for those who cannot tolerate ASA
(4) Steroids reserved for moderate to severe carditis.
- Treat the Infection