Acute Rheumatic Fever (ARF)

Etiology

  • Autoimmune reaction triggered by strep infection, affecting multiple organs

Risk Factors

  • Age 5-15
  • Occurs 2-3w after strep pharyngitis
  • Found most commonly in Africa, India, Middle East, South America

Symptoms

  • Relatively uncommon process assoc w/fever, fatigue
  • Acute/abrupt onset
  • Inflammatory arthritis of large joints typically (e.g. knees, ankles, elbows, wrist), which migrates (present in one area for few weeks, then moves to next)
  • Chest pain, SOB (pan-carditis)
  • Erythema marginatum (< 10% of cases)→ erythematous annular eruption
  • Painless sub-cu nodules
  • (Syndenham's) chorea (in 30% of cases)→ purposeless, spontaneous movements of limbs and torso, facial grimaces; emotional lability
  • Long term risk of mitral or aortic valve dz (later development of murmurs and heart failure)

Physical Exam Findings

  • Pericardial rub
  • Affected joint(s) are warm, red, pain w/movement
  • Choreaform movements
  • A few, small, painless sub-cutaneous nodules, typically over boney prominences or extensor tendons, often symmetric
  • Bright pink, erythematous, blanching, non-puritic macules and papules on trunk/limbs