Rheumatic Fever, 5TH MBBS, (from Adeleke's Principles of Internal Medicine), M2

Rheumatic fever = nonsuppurative inflammatory lesions of joints, heart, subcutaneous tissue, and CNS. Etiology: Group A β‑haemolytic streptococci (GAS). Risk factors: Streptococcal pharyngitis, streptococcal skin infections. Diagnosis – Revised Jones criteria: Requires evidence of preceding GAS infection + 2 major criteria OR 1 major + 2 minor criteria. Major criteria (JONES – mnemonic) : Carditis Migratory polyarthritis Subcutaneous nodules Erythema marginatum Sydenham's chorea Minor criteria: Fever ↑ ESR or CRP Arthralgia ↑ PR interval on ECG Previous rheumatic fever Valve involvement (in order of frequency): Mitral (70%) Aortic (40%) Tricuspid (10%) Pulmonary (2%) Treatment: Bed rest Benzylpenicillin (0.6–1.2 g stat) then phenoxymethylpenicillin (250–500 mg qds PO × 10 days) – for the streptococcal infection. NSAIDs for pain. Haloperidol or diazepam for chorea.