Adult RF

ALSO KNOW AS
Rheumatic fever or RF

DESCRIPTION
* Rheumatic Fever is an inflammation that may follow an infectious episode of the group Streptococcus bacteria -- usually of the throat. In RF there may be heart (carditis) and multiple joint (polyarthritis) damage. RF also may affect the skin (rash, nodules) and the nervous system (e.g., abnormal involuntary movements).

SYMPTOMS
* Joint swelling and tenderness
* May involve many joints
* Fever
* Skin rash (erythema marginatum) and nodules (painless, hard swellings under the skin and overlying bones)
* Nose bleeds (epistaxis)
* Symptoms of RF often occur within 7-35 days after infection.
* In some, symptoms of RF may last 3 months or longer.
* Vomiting
* Abdominal pain
* Sydenham's chorea -- jerky, involuntary, purposeless movements (of legs and arms), muscle weakness, Speech Problems, and emotional instability

CAUSE
* Throat infection with the group A Streptococcus (pharyngitis, scarlet fever) may start an
autoimmune reaction in which the body's defenses, in the process of attacking the bacteria (using Proteins known as antibodies), may damage or cause inflammation -- swelling, irritation, and pain -- to certain body parts, such as the skin, heart valves, joints, and brain.
* The autoimmune response leads to RF.

HOW THE DIAGNOSIS IS MADE
* History of symptoms, illnesses, recent infections, allergies, surgeries, habits
* Medical exam:

1. Fever
2. Rash or nodules
3. Swollen tender joints
4. Chorea may be present
5. Using a stethoscope, the doctor may hear an abnormal flow of blood (murmur) across a damaged heart valve (endocarditis).
6. If the sac that covers the heart is inflamed (pericarditis) there may be chest pain with each breath (pleuritic chest pain), shortness of breath, and a characteristic friction rub may be heard (with a stethoscope) over the chest.

* Tests:

1. Throat (swabbed sample of the throat) cultures may reveal the bacteria early in the disease.
2. Blood tests -- C-reactive protein and ESR indicate ongoing inflammation. ASO (antistreptolysin O) and DNase indicate infection with group A streptococcus.
3. Anemias (low red blood cell count) may be present.
4. Electrocardiogram -- measures the electrical activity of the heart -- may show changes indicating damage to the electrical pathways inside the heart (prolonged P-R interval).
5. Echocardiography -- using sound waves may show fluid around the heart and show the diseased valves.

RISK FACTORS
* Children between ages of 5 -15
* Crowded places like schools, work
* Untreated strepthroat
* Rheumatic Fever

TREATMENT
* Bed rest
* Penicillin is the antibiotic of choice and is given to all patients except those with allergy to penicillin, who receive alternative drugs.
* NSAIDs (such as aspirin) may reduce inflammation of the joints and relieve pain and fever.
* Irregular heart rhythms can be corrected with medications.
* Steroids, such as Prednisone, are used if there is a severe form of carditis (heart inflammation).
* Chorea can be treated with medications such as Haldol.
* Patients often receive penicillin (monthly injections) until adulthood or up to 5 years after an attack of RF.
* Some experts recommend treatment with antibiotics for life, especially if there is severe valve damage.
* The patient with a damaged heart valve may need to take antibiotics before dental and other major procedures.

IF YOU SUSPECT THIS CONDITION
* Contact your physician as soon as you can. If there is high fever, chorea, chest pain, fainting, or shortness of breath, contact 911.

SIMILAR CONDITIONS
* Viral myocarditis
* Kawasaki's syndrome
* Lyme disease
* Infectious arthritis
* Endocarditis or murmurs from other causes