Rheumatic fever

Rheumatic Fever

1. Definition: Rheumatic fever is an inflammatory disease that can occur in children and young adults after a group A streptococcal (GAS) infection, such as strep throat. It is characterized by inflammation in the heart, joints, skin, and brain. Additional context: Rheumatic fever is a major cause of acquired heart disease in children worldwide.

2. Synonyms: Acute rheumatic fever, rheumatic disease, rheumatic heart disease

3. Causes/Etiology: The primary cause of rheumatic fever is a group A streptococcal (GAS) infection, such as strep throat. The infection triggers an autoimmune response, leading to inflammation in the heart, joints, skin, and brain. Additional context: The exact mechanisms of the autoimmune response are not fully understood.

4. Types/Classification: There are two main types of rheumatic fever:

4.1. Acute Rheumatic Fever: This is the most common and severe form of the disease. It occurs within 2-3 weeks after the initial GAS infection and is characterized by:

• Symptoms: Fever, headache, rash, joint pain and swelling, and heart problems.
• Duration: Typically lasts 4-6 weeks.
• Differences: Acute rheumatic fever can lead to rheumatic heart disease if left untreated.

4.2. Subacute Rheumatic Fever: This is a milder form of the disease and occurs within 6-8 weeks after the initial GAS infection.

5. Pathophysiology/Pathology: The pathophysiology of rheumatic fever involves the following steps:

• Initial GAS infection triggers an autoimmune response.
• Antibodies attack the heart, joints, skin, and brain.
• Inflammation occurs in these tissues, leading to damage and scarring.
• The heart is particularly affected, with inflammation of the valves and surrounding tissues.

6. Clinical Features: The clinical features of rheumatic fever include:

• General features:
  • Fever
  • Headache
  • Rash
  • Joint pain and swelling
  • Heart problems
• Specific features:
  • Carditis (inflammation of the heart)
  • Arthritis (joint inflammation)
  • Chorea (involuntary movements)
  • Skin lesions

7. Complications: The complications of rheumatic fever include:

• Acute complications:
  • Carditis
  • Arthritis
  • Chorea
  • Skin lesions
• Chronic complications:
  • Rheumatic heart disease (RHD)
  • Heart failure
  • Arrhythmias
  • Increased risk of stroke

8. Investigations/Diagnosis: The diagnosis of rheumatic fever is made based on a combination of clinical features and laboratory tests, including:

• Routine tests:
  • Blood cultures
  • Complete blood count
  • Electrolyte panel
• Specific tests:
  • ECG (electrocardiogram)
  • Echocardiogram
  • MRI (magnetic resonance imaging)
  • Blood tests for rheumatic fever antibodies

9. Differential Diagnosis: The differential diagnosis of rheumatic fever includes:

• Other autoimmune diseases (e.g., lupus)
• Infections (e.g., Lyme disease)
• Heart conditions (e.g., cardiomyopathy)
• Migraines
• Neurological disorders (e.g., multiple sclerosis)

10. Management/Treatment:

10.1. General Management: The general management of rheumatic fever includes:

• Rest
• Pain management (e.g., acetaminophen)
• Antibiotics (e.g., penicillin) to treat the underlying GAS infection
• Corticosteroids (e.g., prednisone) to reduce inflammation

10.2. Modern Medicine Treatment: The modern medicine treatment of rheumatic fever includes:

• Antibiotics (e.g., penicillin) to treat the underlying GAS infection
• Corticosteroids (e.g., prednisone) to reduce inflammation
• Aspirin to reduce inflammation and pain
• Cardiac medications (e.g., beta blockers) to manage heart problems

10.3. Diet and Lifestyle Advice: The diet and lifestyle advice for patients with rheumatic fever includes:

• A healthy diet with plenty of fruits, vegetables, and whole grains
• Avoiding processed foods and sugary drinks
• Staying hydrated
• Engaging in regular physical activity
• Managing stress

11. Homeopathic Therapeutics:

• Arnica: Causation: Trauma; Characteristic symptoms: Pain, inflammation, swelling; Modalities: Rest, warmth; Mental state: Irritability; Thirst and appetite: Normal; Nature of discharges or secretions: None; Physical generals: Painful joints; Suitable constitution or patient type: Sanguine; How it helps: Arnica reduces inflammation and pain.

• Bryonia: Causation: Overwork, stress; Characteristic symptoms: Pain, inflammation, swelling; Modalities: Rest, cold; Mental state: Irritability; Thirst and appetite: Normal; Nature of discharges or secretions: None; Physical generals: Painful joints; Suitable constitution or patient type: Sanguine; How it helps: Bryonia reduces inflammation and pain.

• Hypericum: Causation: Trauma; Characteristic symptoms: Pain, numbness, tingling; Modalities: Rest, warmth; Mental state: Anxiety; Thirst and appetite: Normal; Nature of discharges or secretions: None; Physical generals: Painful nerves; Suitable constitution or patient type: Melancholic; How it helps: Hypericum reduces pain and inflammation.

• Ledum: Causation: Trauma; Characteristic symptoms: Pain, swelling, bruising; Modalities: Rest, cold; Mental state: Anxiety; Thirst and appetite: Normal; Nature of discharges or secretions: None; Physical generals: Painful joints; Suitable constitution or patient type: Melancholic; How it helps: Ledum reduces inflammation and pain.

• Pulsatilla: Causation: Emotional stress; Characteristic symptoms: Mood swings, irritability; Modalities: Warmth, open air; Mental state: Anxiety; Thirst and appetite: Normal; Nature of discharges or secretions: None; Physical generals: Painful joints; Suitable constitution or patient type: Sanguine; How it helps: Pulsatilla reduces emotional stress and anxiety.

• Rhus tox: Causation: Exposure to cold; Characteristic symptoms: Pain, stiffness, swelling; Modalities: Warmth, exercise; Mental state: Anxiety; Thirst and appetite: Normal; Nature of discharges or secretions: None; Physical generals: Painful joints; Suitable constitution or patient type: Sanguine; How it helps: Rhus tox reduces inflammation and pain.

• Ruta: Causation: Trauma; Characteristic symptoms: Pain, numbness, tingling; Modalities: Rest, warmth; Mental state: Anxiety; Thirst and appetite: Normal; Nature of discharges or secretions: None; Physical generals: Painful nerves; Suitable constitution or patient type: Melancholic; How it helps: Ruta reduces pain and inflammation.

• Silica: Causation: Trauma; Characteristic symptoms: Pain, inflammation, swelling; Modalities: Rest, warmth; Mental state: Anxiety; Thirst and appetite: Normal; Nature of discharges or secretions: None; Physical generals: Painful joints; Suitable constitution or patient type: Sanguine; How it helps: Silica reduces inflammation and pain.

12. Prognosis: The prognosis of rheumatic fever depends on the severity of the disease and the effectiveness of treatment. With prompt and proper treatment, most patients can recover fully. However, some patients may experience chronic complications, such as rheumatic heart disease.

13. Prevention: The prevention of rheumatic fever involves:

• Vaccination against group A streptococcus
• Prompt treatment of strep throat with antibiotics
• Good hygiene practices, such as washing hands frequently
• Avoiding close contact with people who have strep throat

14. Diet: The diet for patients with rheumatic fever should include:

• Plenty of fruits and vegetables
• Whole grains
• Lean protein sources
• Healthy fats
• Avoiding processed foods and sugary drinks