Rheumatic Fever Made Easy (Including Jones Criteria and Mnemonic!)

Summary

This informative video discusses rheumatic fever, an autoimmune condition that can occur following a throat infection with Group A streptococcus. Primarily affecting children aged 5 to 15, it presents symptoms such as high fever, migrating joint pain, cardiac issues, and distinctive skin manifestations. Diagnosis relies on the Jones criteria, distinguishing between major and minor symptoms. Treatment focuses on symptom relief and secondary prophylaxis with long-term antibiotics to prevent recurrence. The video emphasizes the importance of recognizing symptoms early to mitigate potential complications.

Takeaways

• 😀 Rheumatic fever is an autoimmune condition that usually occurs 2-4 weeks after a streptococcal throat infection, mainly affecting children aged 5-15.
• 😀 The incidence of rheumatic fever is low in developed countries but significantly higher in certain indigenous populations in Australia and New Zealand.
• 😀 Genetic predisposition and molecular mimicry between streptococcal antigens and host tissues lead to the development of rheumatic fever.
• 😀 Common symptoms of rheumatic fever include high-grade fever, migrating polyarthritis, and cardiac issues such as pericarditis and myocarditis.
• 😀 The Jones Criteria is used for diagnosing rheumatic fever, which includes both major and minor criteria related to clinical findings.
• 😀 Major criteria include joint involvement, cardiac manifestations, subcutaneous nodules, erythema marginatum, and Sydenham's chorea.
• 😀 Minor criteria include elevated CRP, arthralgia, fever, elevated ESR, prolonged PR interval, and a suggestive history of rheumatism.
• 😀 Diagnostic tests include ECG, chest X-ray, throat culture, and serological tests for anti-streptolysin O and anti-DNase B antibodies.
• 😀 Treatment focuses on symptomatic relief, often with paracetamol or NSAIDs, and long-term antibiotic prophylaxis to prevent recurrence.
• 😀 Patients with carditis may require additional medications such as ACE inhibitors or diuretics, and those with Sydenham's chorea may be treated with carbamazepine or valproic acid.

Q & A

What is rheumatic fever and how does it develop?

Rheumatic fever is an autoimmune condition that typically develops 2 to 4 weeks after a streptococcal throat infection, primarily affecting children aged 5 to 15.

What role does molecular mimicry play in rheumatic fever?

Molecular mimicry occurs when antibodies against Group A Streptococcus antigens mistakenly target similar structures in the body's tissues, leading to autoimmune reactions and symptoms of rheumatic fever.

What are the common symptoms of rheumatic fever?

Common symptoms include high-grade fever, migratory polyarthritis (joint pain), carditis, subcutaneous nodules, erythema marginatum (a rash), and Sydenham's chorea (involuntary movements).

How is rheumatic fever diagnosed?

Diagnosis is based on the Jones criteria, which require evidence of a Group A strep infection along with two major criteria or one major and two minor criteria.

What are the major criteria in the Jones criteria for diagnosing rheumatic fever?

The major criteria include joint involvement, carditis, subcutaneous nodules, erythema marginatum, and Sydenham's chorea.

What minor criteria are used in the diagnosis of rheumatic fever?

The minor criteria include elevated CRP, arthralgia, fever, raised ESR, prolonged PR interval, and a suggestive history.

What is the first-line treatment for rheumatic fever?

The primary treatment focuses on symptomatic relief, particularly with NSAIDs for joint pain, and antibiotics such as benzathine benzyl penicillin for confirmed cases.

How is long-term prevention of rheumatic fever achieved?

Long-term prevention involves secondary prophylaxis with regular injections of benzathine benzyl penicillin or oral erythromycin to prevent recurrence of rheumatic fever.

What is the significance of cardiac involvement in rheumatic fever?

Cardiac involvement, or carditis, can lead to complications such as valve damage, heart failure, and increased risk of atrial fibrillation and infective endocarditis, particularly after repeated attacks.

Why is NSAID use cautioned in suspected cases of rheumatic fever?

NSAIDs should be used cautiously because they may mask the migration of joint pain, which is a major diagnostic criterion for rheumatic fever.