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

Definition and Epidemiology of Acute Rheumatic Fever

Acute Rheumatic Fever (ARF) is an inflammatory disease that develops as a delayed immune response to an infection with group A Streptococcus bacteria, primarily affecting the heart, joints, central nervous system, and skin.

Etiology and Pathophysiology

ARF typically follows an untreated or inadequately treated streptococcal throat infection. Molecular mimicry leads to cross-reactivity where immune responses mistakenly attack host tissues.

Clinical Presentation

• Fever
• Arthritis (migratory polyarthritis)
• Carditis affecting heart valves
• Syndenham's chorea (neurological dysfunction)
• Erythema marginatum (skin rash)

Diagnosis

Diagnosis is primarily clinical based on the Jones criteria, supplemented by laboratory evidence of recent streptococcal infection.

Treatment and Management

• Antibiotic therapy to eradicate streptococcal infection
• Anti-inflammatory medications such as aspirin or corticosteroids
• Cardiac monitoring for long-term complications
• Secondary prophylaxis using penicillin to prevent recurrence

Prognosis and Complications

ARF can lead to chronic rheumatic heart disease (RHD), causing permanent valve damage. Early intervention and adherence to prophylaxis improve outcomes.