Skip to main content

Advertisement

SpringerLink
Log in

Rheumatic fever

  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Rheumatic fever is a multisystem inflammatory disease that occurs as a delayed sequel to group A streptococcal pharyngitis. It is less common than it was 50 years ago but is still a major cause of heart disease in developing areas of the world. The relationship between the site of infection, the type of causative organism, and susceptibility of the host is essential in the development of the disease. Its major clinical manifestations include carditis, migratory polyarthritis, chorea, erythema marginatum, and subcutaneous nodules. It can manifest as an acute febrile illness consisting of migratory polyarthritis involving the large joints, as carditis and valvulitis, or as Sydenham’s chorea with involvement of the central nervous system. The disorder in its milder form resolves itself without sequelae. Carditis is the condition most associated with increased mortality and morbidity and may be fatal in its severe forms. Penicillin is the most appropriate primary and secondary prophylaxis. Antiinflammatory agents provide symptomatic relief but do not prevent rheumatic heart disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Bisno AL: The resurgence of acute rheumatic fever in the United States. Ann Rev Med 1990, 41:319–329.

    Article  PubMed  CAS  Google Scholar 

  2. Kaplan EL: T. Duckett Jones Memorial Lecture. Global assessment of rheumatic fever and rheumatic heart disease at the close of the century. Influences and dynamics of populations and pathogens: a failure to realize prevention? Circulation 1993, 88:1964–1972.

    PubMed  CAS  Google Scholar 

  3. Zamman MM, Yoshiike N, Chowdhury AH, et al.:Socioeconomic deprivation associated with acute rheumatic fever: a hospital-based case-control study in Bangladesh. Pediatr Perinatal Epidemiol 1997, 11:322–332.

    Article  Google Scholar 

  4. Da Silva NA, Faira BA: Acute rheumatic fever, still a challenge. Rheum Clin North Am 1997, 23:545–568.

    Article  Google Scholar 

  5. Stollerman GH: Rheumatic fever. Lancet 1997, 349:935–942.

    Article  PubMed  CAS  Google Scholar 

  6. Fauci A, et al.: Harrison’s Principles of Internal Medicine. New York: McGraw-Hill; 1998:1309–1311.

    Google Scholar 

  7. Gibofsky A, Kerwar S, Zabriskie J: Rheumatic fever: the relationship between host, microbe, and genetics. Rheum Dis Clin North Am 1998, 24:237–261. Comprehensive review of acute rheumatic fever.

    Article  PubMed  CAS  Google Scholar 

  8. Brandt ER, Currie B, Mammo L, Pruksakorn S, Good MF: Can class I epitope of M protein be a diagnostic marker for rheumatic fever in populations endemic for group A streptococcus? Lancet 1998, 351:1860.

    Article  PubMed  CAS  Google Scholar 

  9. Marquez-Diaz MA: Sydenham’s chorea. Psychiatr Clin North Am 1997, 156:25–29.

    Google Scholar 

  10. Yegin O, Coskin M, Ertug H: Cytokines in acute rheumatic fever. Eur J Pediatr 1997, 156:25–29.

    PubMed  CAS  Google Scholar 

  11. Bhatnagar A, Grover A, Ganguly NK: Super-antigen induced T cell responses in acute rheumatic fever and chronic rheumatic heart disease patients. Clin Exp Immunol 1999, 116:100–106.

    Article  PubMed  CAS  Google Scholar 

  12. Guedez Y, Kotby A, El-Demellawy M, et al.: HLA class II association with rheumatic heart disease is more evident and consistent among clinically homogeneous patients. Circulation 1999, 99:2784–2790.

    PubMed  CAS  Google Scholar 

  13. Gerbase-DeLima M, Scala LCN, Temin J, Santos DV, Otto PA:Rheumatic fever and the HLA complex: a co-segregation study. Circulation 1994, 89:138–141.

    PubMed  CAS  Google Scholar 

  14. Brandt ER, Hayman WA, Currie B, et al.: Functional analysis of IgA antibodies specific for a conserved epitope within the M protein of group A streptococcus from Australian Aboriginal endemic communities. Int Immunol 1999, 11:569–576.

    Article  PubMed  CAS  Google Scholar 

  15. Thatai D, Zoiten G: Current guidelines for the treatment of patients with rheumatic fever. Drugs 1999, 57:545–555.

    Article  PubMed  CAS  Google Scholar 

  16. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki’s Disease of the Council on Cardiovascular Medicine: Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. JAMA 1992, 268:2069–2073.

    Article  Google Scholar 

  17. Khaled A, Majeed HA: Acute rheumatic fever: diagnosis and treatment. Pediatr Ann 1998, 27:295–300.

    Google Scholar 

  18. Capizzi SA, Levy NT, Enrique-Sarano M: Rheumatic fever revisited. Postgrad Med J 1997, 102:65–71.

    CAS  Google Scholar 

  19. Pinals RS: Polyarthritis and fever. N Engl J Med 1994, 330:769–764. Excellent article comparing different types of arthritis.

    Article  PubMed  CAS  Google Scholar 

  20. Narula J, Malhotra A, Yasuda T, et al.: Usefulness of antimyosin antibody imaging for the detection of active rheumatic myocarditis. Am J Cardiol 1999, 84:946–949.

    Article  PubMed  CAS  Google Scholar 

  21. Narula J, Chandrasekhar Y, Rahimtoola S: Diagnosis of active rheumatic carditis: the echoes of change. Circulation 1999, 100:1576–1581.

    PubMed  CAS  Google Scholar 

  22. Elevi M, Celebi A, Tombul T, Gokalp SA: Cardiac involvement in Sydenham’s chorea: clinical and Doppler echocardiography findings. Acta Paediatrica 1999, 88:1074–1077.

    Article  Google Scholar 

  23. Swedo SE, Leonard HL, Garvey M, et al.: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the fist 50 cases. Am J Psychiatr 1998, 155:264–271.

    PubMed  CAS  Google Scholar 

  24. Aviles RJ, Ramakrishna G, Mohr DN, Michet CJ: Poststreptococcal reactive arthritis in adults: a case series. Mayo Clin Proc 2000, 75:144–147.

    Article  PubMed  CAS  Google Scholar 

  25. Moon RJ, Greene MG, Rehe GT, Katona IM: Poststreptococcal reactive arthritis in children: a potential predecessor of rheumatic heart disease. J Rheumatol 1995, 22:529–553.

    PubMed  CAS  Google Scholar 

  26. Bisno AL: Group A streptococcal infection and acute rheumatic fever. N Engl J Med 1991, 325:783–793.

    Article  PubMed  CAS  Google Scholar 

  27. Jansen TL, Janssen M, Jong AJ, Jeurissen ME: Post-streptococcal reactive arthritis: a clinical and serological description, revealing its distinction from acute rheumatic fever. J Intern Med 1999, 245:261–267.

    Article  PubMed  CAS  Google Scholar 

  28. Gutierrez-Urena S, Molina J, Molina JF: Poststreptococcal reactive arthritis, clinical course, and outcome in 6 adult patients. J Rheumatol 1995, 22:1710–1713.

    PubMed  CAS  Google Scholar 

  29. Deighton C: Beta haemolytic streptococci and reactive arthritis in adults. Ann Rheum Dis 1993, 52:475–482.

    Article  PubMed  CAS  Google Scholar 

  30. Schattner A: Poststreptococcal reactive rheumatic syndrome. J Rheumatol 1996, 23:1297–1298.

    PubMed  CAS  Google Scholar 

  31. Gerber MA: Antibiotic resistance: relationship to persistence of group A streptococci in the upper respiratory tract. Pediatrics 1996, 97:971–975.

    PubMed  CAS  Google Scholar 

  32. Shulman ST: Evaluation of penicillins, cephalosporins, and macrolides for therapy of streptococcal pharyngitis. Pediatrics 1996, 97:955–959.

    PubMed  CAS  Google Scholar 

  33. Bisno AL, Gerber MA, Gwaltney JM, et al.: Diagnosis and management of group A streptococcal pharyngitis: a practice guideline. Clin Infect Dis 1997, 25:574–583.

    Article  PubMed  CAS  Google Scholar 

  34. Albert DA, Harrison HL: The treatment of rheumatic carditis: a review and meta-analysis. Medicine 1995, 74:1–12.

    Article  PubMed  CAS  Google Scholar 

  35. Osmon DR: Antimicrobial prophylaxis in adults. Mayo Clin Proc 2000, 75:98–109.

    Article  PubMed  CAS  Google Scholar 

  36. Snitcowsky R: Rheumatic fever prevention in industrializing countries: problems and approaches. Pediatrics 1996, 97:996–998.

    PubMed  CAS  Google Scholar 

  37. Lue HC, Wu MH, Wang JR, Wu FF, Wu YN: Three-versus four-week administration of benzathine penicillin G: effects on incidence of streptococcal infections and recurrences of rheumatic fever. Pediatrics 1996, 97:984–988.

    PubMed  CAS  Google Scholar 

  38. Markowitz M, Lue HC: Allergic reactions in rheumatic fever patients on long-term benzathine penicillin G: the role of skin testing for penicillin allergy. Pediatrics 1996, 97:981–983.

    PubMed  CAS  Google Scholar 

  39. Bisno AL: Acute pharyngitis: etiology and diagnosis. Pediatrics 1996, 97:949–954.

    PubMed  CAS  Google Scholar 

  40. Dale JB: Group A streptococcal vaccines. Pediatr Ann 1998, 27:301–307.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Rheumatology, UMDNJ-Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, PO Box 19, MEB-484, 08903-0019, New Brunswick, NJ, USA

    Eugenia Rullan MD & Leonard H. Sigal MD

Authors
  1. Eugenia Rullan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonard H. Sigal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rullan, E., Sigal, L.H. Rheumatic fever. Curr Rheumatol Rep 3, 445–452 (2001). https://doi.org/10.1007/s11926-996-0016-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-996-0016-4

Keywords

Search

Navigation