Pathophysiology, Clinical Manifestations, Complications, Diagnosis, Management, and Prevention of Acute Rheumatic Fever

Pathophysiology of Acute Rheumatic Fever

Acute Rheumatic Fever (ARF) is an inflammatory disease that can develop as a complication of untreated streptococcal throat infection. It results from an autoimmune response to Group A Streptococcus (GAS) infection, leading to multisystem involvement.

Clinical Manifestations

• Carditis (inflammation of the heart tissue)
• Arthritis (migratory polyarthritis affecting large joints)
• Chorea (neurological disorder causing involuntary movements)
• Erythema marginatum (rash with distinct patterns)
• Subcutaneous nodules (painless, firm nodules under the skin)

Complications

Severe cases of ARF can lead to chronic rheumatic heart disease, resulting in valvular damage that may require surgical intervention. Heart failure is a long-term consequence in untreated cases.

Diagnosis

Diagnosis is based on the Jones criteria, which categorize major and minor clinical findings. Laboratory confirmation of prior streptococcal infection is essential.

Management

• Anti-inflammatory therapy using aspirin or corticosteroids
• Antibiotic treatment to eradicate residual streptococcal infection
• Supportive care including bed rest and symptom management
• Regular follow-ups to monitor cardiac involvement

Prevention

Primary prevention involves prompt antibiotic treatment of streptococcal throat infections. Secondary prevention with prophylactic antibiotics helps prevent recurrence in high-risk individuals.