Acute Rheumatic Fever

Acute Rheumatic Fever

1. Definition Acute Rheumatic Fever (ARF) is an inflammatory disease that occurs after a group A streptococcal infection, usually strep throat. It affects the heart, joints, skin, and brain.

2. Causes / Etiology ARF is caused by group A streptococcal infection, which triggers an autoimmune response that leads to inflammation in the body.

3. Types or Classification

• Poststreptococcal Reactive Arthritis: A type of ARF that affects the joints.
• Sydenham's Chorea: A type of ARF that affects the nervous system.
• Subacute Rheumatic Fever: A type of ARF that affects the heart and joints.
• Acute Rheumatic Fever: The most common type of ARF that affects the heart, joints, skin, and brain.

4. Pathology Step 1: Group A streptococcal infection triggers an autoimmune response. Step 2: The immune system produces antibodies that attack the heart, joints, skin, and brain. Step 3: Inflammation occurs in the affected tissues, leading to damage and dysfunction.

The immune system's immune complex deposition in the heart tissues leads to inflammation and damage to the heart valves (endocarditis), heart muscle (myocarditis), and pericardium (pericarditis).

5. Clinical Features General Features:

• Fever
• Joint pain and swelling (arthralgia and arthritis)
• Skin rash
• Fatigue

Specific Features:

• Migratory polyarthritis (joint pain and swelling that moves from one joint to another)
• Carditis (inflammation of the heart)
• Subcutaneous nodules (small, painless nodules on the skin)
• Erythema marginatum (a rash that appears as a ring or ring-like shape)

6. Complications Acute Complications:

• Cardiac complications (heart failure, arrhythmias)
• Respiratory complications (pneumonia)
• Renal complications (kidney failure)

Chronic Complications:

• Rheumatic heart disease (permanent damage to the heart valves)
• Recurrent ARF attacks
• Chronic kidney disease

7. Diagnosis / Investigations

• Routine tests: Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP)
• Special tests: Anti-streptolysin O (ASO) titer, Anti-DNase B (ADNase B) titer, Echocardiogram

8. Management

• General Management: Rest, hydration, pain management
• Modern Treatment: Antibiotics to treat the underlying streptococcal infection, anti-inflammatory medications to reduce inflammation
• Dietary Advice: A balanced diet, avoidance of salt and sugar, regular exercise

9. Homeopathic Therapeutics

• Belladonna: High fever, headache, joint pain and swelling
• Lachesis: Joint pain and swelling, skin rash
• Rhus Tox: Joint pain and swelling, skin rash, fever
• Arsenic Album: Fever, joint pain and swelling, skin rash, fatigue
• Ferrum Phos: Fever, joint pain and swelling, skin rash, fatigue