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

Introduction

Acute Rheumatic Fever (ARF) is an inflammatory disease triggered by an immune response to Group A Streptococcus (GAS) infection. It primarily affects the joints, heart, skin, and central nervous system, leading to significant long-term health consequences.

Pathophysiology

ARF occurs due to a misdirected immune response, where antibodies against GAS cross-react with human tissues, particularly affecting the heart valves and joints. This molecular mimicry leads to chronic inflammation and tissue damage.

Clinical Manifestations

• Carditis – inflammation affecting the heart valves, myocardium, and pericardium.
• Polyarthritis – migratory arthritis affecting large joints.
• Erythema marginatum – characteristic rash with pink, non-itchy lesions.
• Syndenham's chorea – involuntary movements caused by central nervous system involvement.
• Subcutaneous nodules – firm, painless lumps under the skin.

Complications

Long-term complications of ARF include chronic rheumatic heart disease, which may lead to heart valve deformities, heart failure, and an increased risk of infective endocarditis.

Diagnosis

Diagnosis is based on the modified Jones criteria, which require evidence of preceding streptococcal infection along with major and minor clinical manifestations.

Management and Prevention

Acute Treatment

• Antibiotics (e.g., penicillin) to eliminate streptococcal infection.
• Anti-inflammatory therapy such as aspirin or corticosteroids.
• Supportive care for cardiac complications.

Long-Term Prevention

• Secondary prophylaxis with monthly penicillin injections to prevent recurrence.
• Regular cardiac monitoring for early detection of complications.
• Public health measures to reduce streptococcal infections.

Conclusion

Early diagnosis and comprehensive management of Acute Rheumatic Fever are essential to prevent complications such as rheumatic heart disease. Long-term follow-up and preventive measures, including antibiotic prophylaxis, can significantly reduce disease burden.