From the Guidelines
The joint manifestations of Rheumatic (Acute Rheumatic Fever) heart disease are primarily migratory polyarthritis and polyarthralgia 1.
Joint Manifestations
- Migratory polyarthritis: considered a major manifestation of ARF, characterized by joint pain and swelling that migrates from one joint to another 1
- Polyarthralgia: considered a minor manifestation in low-risk populations, but can be a major manifestation in moderate- to high-risk populations after exclusion of other causes 1
Diagnosis
The diagnosis of ARF is based on the revised Jones criteria, which include major and minor manifestations 1.
- Major manifestations: carditis, arthritis (polyarthritis or monoarthritis), chorea, erythema marginatum, and subcutaneous nodules
- Minor manifestations: polyarthralgia, fever, elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), and prolonged PR interval It is essential to note that joint manifestations can only be considered in either the major or minor categories, but not both in the same patient 1.
Poststreptococcal Reactive Arthritis
Some patients may develop poststreptococcal reactive arthritis (PSRA), which is characterized by arthritis that occurs 3 to 14 days after streptococcal pharyngitis, with prolonged symptoms and protracted arthritis that fails to respond promptly to salicylate therapy 1. The relationship between PSRA and ARF remains unresolved 1.
From the Research
Joint Manifestations of Rheumatic Heart Disease
The joint manifestations of Rheumatic (Acute Rheumatic Fever) heart disease are characterized by:
- Arthritis, which is more frequent than arthralgia 2
- Joint involvement, which is one of the most frequent manifestations of Acute Rheumatic Fever (ARF), along with cardiovascular involvement 2
- No specific pattern of joint involvement, such as migratory arthritis, can be labeled as typical 2
- Joint swelling and tenderness to palpation, with morning stiffness and severe motion impairment in the involved joints, similar to those found in Rheumatoid Arthritis 3
Key Findings
- Cardiovascular and joint involvements are the most frequent manifestations of ARF 2
- Mitral insufficiency is the most frequently detected echocardiographic sign, and its association with aortic insufficiency is common 2
- The incidence of ARF is directly proportional to overcrowding and poor socioeconomic conditions 4
- Timely treatment of group A streptococcal infection can prevent ARF, and penicillin prophylaxis can prevent recurrence of ARF 4
Diagnosis and Prevention
- The 2015 modified Jones criteria are used to diagnose ARF, but there is no gold standard laboratory test 4
- Secondary prophylaxis with benzathine penicillin G has been shown to decrease the incidence of RHD and is key to RHD control 4
- Prevention of recurrent ARF is the most effective way to prevent RHD 4