Acute Rheumatic Fever (ARF): Evolution, Natural History, and Treatment

Clinical Manifestations and Diagnosis of ARF

Acute Rheumatic Fever (ARF) is an autoimmune inflammatory disease that occurs as a sequela of streptococcal pharyngitis. It primarily affects the heart, joints, skin, and central nervous system.

Etiology and Pathogenesis

ARF develops due to a maladaptive immune response to Group A Streptococcus infection. Cross-reactivity between streptococcal antigens and human tissues leads to inflammation and damage.

Clinical Manifestations

• Carditis: Involvement of heart valves (pancarditis), leading to rheumatic heart disease.
• Polyarthritis: Migratory arthritis affecting large joints.
• Sydenham’s Chorea: Neurological symptoms such as involuntary movements.
• Erythema Marginatum: Distinctive rash associated with ARF.
• Subcutaneous Nodules: Firm, painless nodules typically over bony prominences.

Diagnosis

Diagnosis is based on the revised Jones criteria, which include major and minor manifestations combined with evidence of prior streptococcal infection.

Treatment

• Antibiotic Therapy: Penicillin to eradicate streptococcal infection.
• Anti-inflammatory Treatment: Aspirin or corticosteroids for symptom relief.
• Secondary Prophylaxis: Long-term penicillin prophylaxis to prevent recurrence.

Prognosis and Long-term Effects

Timely intervention reduces complications, but recurrent ARF can lead to chronic rheumatic heart disease, requiring surgical intervention.