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Current Clinical Profile of Acute Rheumatic Fever and Recurrent Acute Rheumatic Fever in Pakistan

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Abstract

Inclusion of echocardiography as diagnostic tool and polyarthralgia and monoarthritis as major criteria for high-risk populations in the Revised Jones Criteria 2015 is likely to surface substantial variability in clinical manifestations among various populations. This study aimed to compare clinical profile of patients presenting with first and recurrent episodes of acute rheumatic fever (ARF) using most recent criteria. 130 consecutive patients with ARF were included in the study from August 2019 to March 2022. World Heart Federation standardized echocardiographic criteria were used for cardiac evaluation. The socio-demographic variables, clinical details and relevant investigations were recorded. Median age was 13(6–26) years. Male to female ratio was 1.6:1. Majority was of low socioeconomic status (90%) and with > 5 family members in a house (83.8%). 27 patients (20.8%) were with ARF while 103 (79.2%) with recurrent ARF. Carditis was the most common presenting feature (n = 122, 93.8%), followed by polyarthralgia (n = 46, 35.4%), polyarthritis (n = 32, 24.6%), subcutaneous nodules (n = 10, 7.7%), monoarthritis (n = 10, 7.7%), and chorea (n = 5, 3.8%). Monoarthralgia was more common in ARF than recurrence (29.4% vs. 3.2%, p = 0.004). Carditis (97.1% vs. 81.5%, p = 0.01) and congestive cardiac failure (18.5% vs. 5.9%, p = 0.001) were more common in recurrent ARF than ARF. Diagnostic categorization of Jones criteria for different populations has highlighted important variability in clinical presentation of ARF. Monoarthralgia is common in first episode of ARF. Carditis is the most common feature in recurrent ARF. Polyarthralgia is seen with higher frequency that polyarthritis. Subcutaneous nodules seem to be more common in our population.

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References

  1. Gewitz MH, Baltimore RS, Tani LY et al (2015) 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. Circ 131:1806–1818

    Article  Google Scholar 

  2. Tubridy-Clark M, Carapetis JR (2007) Subclinical carditis in rheumatic fever: a systematic review. Int J Cardiol 119:54–58

    Article  PubMed  Google Scholar 

  3. Carapetis JR, Currie BJ (2001) Rheumatic fever in a high incidence population: the importance of monoarthritis and low grade fever. Arch Dis Child 85:223

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Parnaby MG, Carapetis JR (2010) Rheumatic fever in indigenous Australian children. J Paediatr Child Health 46:527–533. https://doi.org/10.1111/j.1440-1754.2010.01841.x

    Article  PubMed  Google Scholar 

  5. Cann MP, Sive AA, Norton RE, McBride WJ, Ketheesan N (2010) Clinical presentation of rheumatic fever in an endemic area. Arch Dis Child 95:455–457. https://doi.org/10.1136/adc.2008.157107

    Article  PubMed  Google Scholar 

  6. Majeed HA, Khan N, Dabbagh M, Naidi K, Khateeb N (1981) Acute rheumatic fever during childhood in Kuwait: the mild nature of initial attack. Ann Trop Paediatr 1(1):13–20

    Article  CAS  PubMed  Google Scholar 

  7. Caldas AM, Terreri MT, Moises VA et al (2008) What is the true frequency of carditis in acute rheumatic fever? A prospective clinical and Doppler blind study of 56 children with up to 60 months of follow-up evaluation. Pediatr Cardiol 29:1048–1053

    Article  PubMed  Google Scholar 

  8. Narang R, Saxena A, Ramakrishnan S, Gupta S, Juneja RK, Kothari S (2020) : Characteristics of children with acute rheumatic carditis from a high-incidence region: importance of unexplained worsening of functional class. Cardiol 145:522–528. https://doi.org/10.1159/000508035

    Article  CAS  Google Scholar 

  9. Suman S, Kumar R, Jyoti D, Agrawal PK, Parmar V (2017) Clinical profile of acute rheumatic fever patients attending a tertiary care hospital in eastern Bihar. India Int J Adv Med 4:1218–1221

    Article  Google Scholar 

  10. Chagani HS, Aziz K (2003) Clinical profile of acute rheumatic fever in Pakistan. Cardiol in the Young 13:28–35

    Article  Google Scholar 

  11. Sheikh AM, Sadiq M, Rehman AU (2016) Changing clinical profile of Clinical profile of acute rheumatic fever and rheumatic recurrence. JAMC 28(1):141–5

    PubMed  Google Scholar 

  12. Reményi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, Lawrenson J, Maguire G, Marijon E, Mirabel M et al (2012) World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease—an evidence-based guideline. Nat Rev Cardiol 9:297–309

    Article  PubMed  PubMed Central  Google Scholar 

  13. Burke RJ, Chang C (2014) Diagnostic criteria of acute rheumatic fever. Autoimmun Rev 13(4-5):503–507. https://doi.org/10.1016/j.autrev.2014.01.036

  14. Rizvi SF, Khan MA, Kundi A, Samad A, Pasha O (2004) Status of rheumatic heart disease in rural Pakistan. Heart 90:394–399

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Sadiq M, Islam K, Abid R, Latif F, Rehman AU, Waheed A et al (2009) Prevalence of rheumatic heart disease in school children of urban Lahore. Heart 95:353–357

    Article  CAS  PubMed  Google Scholar 

  16. Auckland K, Mittal B, Cairns BJ, Garg N, Kumar S, Mentzer AJ, Kado J, Perman ML, Steer AC, Hill AVS et al (2020) The human leukocyte antigen locus and rheumatic heart disease susceptibility in South Asians and Europeans. Sci Rep 10:1–9

    Article  Google Scholar 

  17. Parks T, Network PIRHDG, Mirabel MM, Kado J, Auckland K, Nowak J, Rautanen A, Mentzer AJ, Marijon E, Jouven X et al (2017) Association between a common immunoglobulin heavy chain allele and rheumatic heart disease risk in Oceania. Nat. Commun 8:1–10

    Article  Google Scholar 

  18. Rwebembera J, Nascimento BR, Minja NW, de Loizaga S, Aliku T, dos Santos LPA, Galdino BF, Corte LS, Silva VR, Chang AY et al (2022) Recent advances in the rheumatic fever and rheumatic heart disease continuum. Pathog 11:179. https://doi.org/10.3390/pathogens11020179

    Article  CAS  Google Scholar 

  19. Mahmudi E, Ashrafzadeh F, Talebi S, Ghaneh F, Vahid Jafari (2006) Acute rheumatic fever in the North East of Iran: a study of 80 cases. J Tehran Univ Heart Cent. 3:151–154

    Google Scholar 

  20. Erdem S, Demir F, Ayana M, Canan O, Okuducu YK, Arslan A, Kucukosmanoglu O, Özbarlas N (2020) Acute rheumatic fever in south-east of Turkey: clinical features and epidemiological evaluation of the patients over the last 25 years. Cardiol Young 30(8):1086–1094. https://doi.org/10.1017/S1047951120001596

    Article  PubMed  Google Scholar 

  21. Steer AC, Kado J, Jenney AW, Batzloff M, Waqatakirewa L, Mulholland EK, Carapetis JR (2009) Acute rheumatic fever and rheumatic heart disease in Fiji: prospective surveillance, 2005–2007. M J Aust 190(3):133–135. https://doi.org/10.5694/j.1326-5377.2009.tb02312.x

    Article  Google Scholar 

  22. Lawrence JG, Carapetis JR, Griffiths K, Edwards K, Condon JR (2013) Acute rheumatic fever and rheumatic heart disease: incidence and progression in the Northern Territory of Australia, 1997 to 2010. Circ 128:492–501. https://doi.org/10.1161/CIRCULATIONAHA.113.001477

    Article  Google Scholar 

  23. Sanyal SK, Thaper MK, Ahmed SA, Hooja V, Tewari P (1974) The initial attack of acute rheumatic fever during childhood in North India. A prospective study of the clinical profile. Circ 49:7–12. https://doi.org/10.1161/01.CIR.49.1.7

    Article  CAS  Google Scholar 

  24. Beg A, Sadiq M (2008) Subclinical valvulitis in children with acute rheumatic fever. Pediatr Cardiol 29:619–623. https://doi.org/10.1007/s00246-007-9173-0

    Article  PubMed  Google Scholar 

  25. Beaton AZ, Okello E, Rwebembera J, Grobler A, Engelman D, Carapetis J, Canales L, Dewyer A, Lwabi P, Mirabel M (2021) A randomized controlled trial of secondary antibiotic prophylaxis for latent rheumatic heart disease. Circ 144:A12503

    Article  Google Scholar 

  26. Lindholm DE, Whiteman IJ, Oliver J, Cheung MMH, Hope SA, Brizard CP, Horton AE, Sheridan B, Hardy M, Osowicki J, Steer AC, Engelman D (2023) Acute rheumatic fever and rheumatic heart disease in children and adolescents in Victoria, Australia. J Paediatr Child Health 59:352–359. https://doi.org/10.1111/jpc.16305

    Article  PubMed  Google Scholar 

  27. Feinstein AR, Spagnuolo M (1962) The clinical patterns of acute rheumatic fever: a reappraisal. Med (Baltimore) 41:279

    Article  CAS  Google Scholar 

  28. Webb RH, Grant C, Harnden A (2015) Acute rheumatic fever. BMJ 351:h3443. https://doi.org/10.1136/bmj.h3443

    Article  PubMed  Google Scholar 

  29. Blyth CC, Robertson PW (2006) Anti-streptococcal antibodies in the diagnosis of acute and post-streptococcal disease: streptokinase versus streptolysin O and deoxyribonuclease B. Pathology 38:152

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Paediatric Cardiology, The Children’s Hospital, University of Child Health Sciences, Ferozepur Road, Lahore, 54000, Pakistan

    Noor Masood Sadiq, Gul Afshan, Ahmad Usaid Qureshi & Masood Sadiq

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  1. Noor Masood Sadiq
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  2. Gul Afshan
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Contributions

NMS: Data curation; formal analysis; roles/writing—original draft. GA: Data curation; formal analysis; investigation; methodology. AUQ: Formal analysis; supervision; validation; writing—review & editing. MS: Conceptualization; supervision; validation; writing—review & editing.

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Correspondence to Masood Sadiq.

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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Institutional review Board of The Children's hospital, Lahore. Pakistan Approval Reference Number: CH/ICH 2019/433, Dated 31/03/2019.

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Sadiq, N.M., Afshan, G., Qureshi, A.U. et al. Current Clinical Profile of Acute Rheumatic Fever and Recurrent Acute Rheumatic Fever in Pakistan. Pediatr Cardiol 45, 240–247 (2024). https://doi.org/10.1007/s00246-023-03378-5

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