From the Guidelines
Rheumatic fever is diagnosed using the Jones criteria, which requires evidence of a preceding Group A Streptococcal infection plus either two major criteria or one major and two minor criteria, with echocardiography playing a crucial role in assessing cardiac involvement, as recommended by the 2024 study in The Lancet Global Health 1. The diagnostic criteria for Rheumatic (Acute Rheumatic) Fever include:
- Major criteria: carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules
- Minor criteria: fever, arthralgia, elevated inflammatory markers (ESR or CRP), and prolonged PR interval on ECG Evidence of streptococcal infection can be confirmed through:
- Positive throat culture
- Rapid strep test
- Elevated ASO titers Initial evaluation should include:
- Complete blood count
- ESR
- CRP
- Throat culture
- ASO titers
- ECG
- Echocardiogram to assess for cardiac involvement, particularly valvular damage, as emphasized by the 2024 study in The Lancet Global Health 1 and the 2015 study in Circulation 1. Treatment involves:
- Eradicating the streptococcal infection with penicillin (typically penicillin V 250-500 mg orally twice daily for 10 days) or amoxicillin (50 mg/kg/day, maximum 1000 mg daily for 10 days)
- Anti-inflammatory treatment with aspirin (80-100 mg/kg/day divided into 4 doses) or naproxen to manage arthritis and fever
- Severe carditis may require corticosteroids Long-term prophylaxis with benzathine penicillin G injections every 3-4 weeks or daily oral penicillin is necessary to prevent recurrence, with duration depending on cardiac involvement, as recommended by the 2015 study in Circulation 1. Regular cardiac follow-up is essential to monitor for valvular damage, highlighting the importance of echocardiography in the diagnosis and management of Rheumatic Fever, as supported by the 2024 study in The Lancet Global Health 1 and the 2015 study in Circulation 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnostic Criteria for Acute Rheumatic Fever
The diagnosis of acute rheumatic fever is based on the presence of documented preceding Group A Streptococcal infection, in addition to the presence of two major manifestations or one major and two minor manifestations of the Jones criteria 2. The Jones criteria were first developed in 1944 and have been modified throughout the years, most recently in 1992 and 2015 3, 4, 5, 6.
Major Manifestations
The major manifestations of acute rheumatic fever include:
- Carditis
- Polyarthritis
- Sydenham's chorea
- Subclinical carditis found on echocardiogram (added in the 2015 revised Jones criteria) 3, 4, 5
- Aseptic monoarthritis and polyarthralgia (used as major criteria in moderate-high risk populations) 4
Minor Manifestations
The minor manifestations of acute rheumatic fever include:
- Body temperature of 38.5°C and above (for low-risk populations) or 38°C and above (for moderate-high risk populations) 4
- Erythrocyte sedimentation rate of 30 mm/h and above 4
- Monoarhtralgia (used as a minor criterion among joint findings) 4
Evaluation Methods
The evaluation of acute rheumatic fever involves:
- Clinical diagnosis based on the Jones criteria 2
- Documentation of antecedent Group A Streptococcal infection 2
- Echocardiographic examination to detect subclinical carditis (recommended by the American Heart Association) 5
- Laboratory tests to detect antecedent Group A Streptococcal infection, such as antibody tests 6
Population Risk Categories
The 2015 revised Jones criteria subdivide the population into moderate- to high-risk and low-risk categories 3, 4. The diagnostic criteria differ between these two categories, with moderate-high risk populations having additional major criteria such as subclinical carditis and aseptic monoarthritis.