Rheumatic Fever

This is an important cause of arthritis in children which follows throat infection by micro-organisms known as streptococci. Large joints of extremities such as knees, ankles, elbows and wrists swell one after other (fleeting arthritis). Untreated swelling subsides within a week or so and easily responds to anti-inflammatory pain killers. Arthritis lasts for 4 weeks or less and never causes permanent damage. Swelling of heart (carditis) is a serious consequence of rheumatic fever. Rheumatic heart disease occurring 10-20 years after original attack of acute rheumatic fever is the most common form of acquired disease of heart valves. Nodules and rashes over skin and involuntary limb movements (Chorea) are other important features of acute rheumatic fever. Laboratory investigations are not really helpful in diagnosis. ASO titre* is a frequently ordered but usually misinterpreted laboratory investigation. A four-fold rise (320 Todd Units) is significant in a patient with other features of rheumatic fever. Sonography of heart (Echo-cardiography) is the most sensitive test for diagnosis of heart involvement in this disease. American Heart Association has issued guidelines for diagnosis of initial attack of Acute Rheumatic Fever. Treatment consists of high dose aspirin, bed rest and steroids in severe heart involvement. Penicillin (Long-acting, Injection once in 3 weeks) is prescribed for indefinite period to avoid recurrence of rheumatic fever and infection of damaged valves.