• Arthritis that affects numerous joints but emerges in on joint at a time • Abnormal heart beat • Chest Pain • Red patches on skin • Small painless lumps beneath skin • Rapid, involuntary movements in muscles of extremities or face
Must have two major manifestations or • One major manifestation and two minor manifestations
Exceptions to Jones Criteria
• Chorea may be the sole manifestation of ARF • Indolent carditis may be the sole manifestation in patient who fail to seek early medical treatment • Individuals with a history of ARF should be presumed to have recurrence manifestations.
Must have supportive evidence of antecedent group A Streptococcal pharyngitis • Positive throat culture • Positive rapid streptococcal antigen test • Elevated (especially rising) streptococcal antibody testing:
• Other arthralgias • Fever: 101 F to 104 F • Elevated acute phase reactants (ESR and CRP) • Prolonged PR Interval on ECG • Prior history of rheumatic fever
• Symptomatic relief of acute disease manifestations • Eradication of group A beta-hemolytic streptococcus • Prophylaxis against future infection to prevent recurrent cardiac disease
What therapy will slowdown the valvular portion of the disease process
There is no therapy that slows the progression of valvular damage in patients with ARF
Anti-inflammatory agents used for symptomatic relief of ARF
• Aspirin: 4-8 grams qd • Serum levels at 20-30mg/dl • Dramatic relief in fever and arthralgias • Continue until all symptoms are absent and ESR levels are normalized
Treatment of Carditis:
• Treat heart failure using conventional therapy • Treat heart block using conventional therapy • Corticosteroids: • Prednisone 2mg/kg/day • Valve repair or replacement for non- responsive heart failure
Antibiotic therapy with penicillin should be started and maintained for at least 10 days, regardless of the presence or absence of pharyngitis at the time of diagnosis.
What ABX should you use to treat a pt with ARF that also has a penicillin allergy?
• PCN allergic patients should be treated with Erythromycin
Children: Rx: Penicillin VK
Adults: Rx: Penicillin VK
Bicillin LA may be used IM once in lieu of
Children Bicillin Rx
Adults Bicillin Rx
1.2 million UNITS
the goal of antibiotic prophylaxis against Group A Beta-Hemolytic Streptococcus is to prevent recurrence of acute rheumatic fever.
How long should you continue a pt on ABX prophylaxis?
Consensus seems to be that therapy should be continued at least until the patient is a young adult (18-20 years old) or five years following acute manifestation of ARF
According to WHO guidelines Patients with proven carditis should remain on ABX therapy until?
5 years therapy or until age 18
According to WHO guidelines Patients with mild mitral regurgitation should remain on ABX therapy until?
at least 10 years prophylaxis or until age 25
According to WHO guidelines Patients with severe valve disease/replacement should remain on ABX therapy until?
What is the most severe sequela of ARF
Rheumatic heart disease • Occurs 10-20 years after the original illness • Major cause of valvular heart disease worldwide • Likely to occur in at least 50% of patients with carditis on initial presentation
What valve is most commonly affected in rheumatic heart disease
Mitral valve (mitral stenosis)
Other than the mitral valve what other valve is commonly affected
The Aortic Vavlve
The Valve rarely affected in rheumatic heart disease