L19 Rheumatic Fever

When strep throat is untreated, in ❌% of cases, it will develop into rheumatic fever.
Acute rheumatic fever is a ❌ disease, causing arthritis (in 60 - 80% of cases), carditis (in 30-45% of cases), and neurological symptoms (10% of cases). Essentially this means ❌ and ❌ tissue can become inflamed. Some patients will progress to chronic rheumatic ❌.

Risk factors for rheumatic fever include poverty and social disadvantage.
This implies ❌ nutrition and ❌. The genetics and ethnicity of the ❌ also influence risk. It is a ❌ disease so immune function
genes, both innate and acquired matter.
The bacterial genetics of the ❌ also change risk.

Pathogenesis of ARF:
1. ❌ throat infection
2. Activation of innate & acquired ❌
3. Production of anti-GAS ❌ that cross reacts with ❌ tissues
4. Activation of ❌ cells (eg myosin)

The pathology of ARF in joints is an immune ❌ formation (with antibody and ❌ proteins), and an influx of inflammatory ❌. It's commonly in ❌ joints and affects ❌ joints. This can occur simultaneously ❌ can be ‘migratory’. It lasts for days/weeks, then resolves. It ❌ to anti- inflammatories.

Chorea is an abnormal involuntary movement disorder, and ARF can cause temporary chorea. In ARF chorea:
1. Antibody binds to proteins on a ❌ – causing altered signalling and increased levels of ❌. This causes involuntary ❌ that affects the trunk, limbs, face (grimaces, frowns). We only treat if ❌, with anti- epileptic ❌ acid or ❌.

ARF chorea develops ❌ after GAS infection and is also referred to as Sydenham’s chorea or St. Vitus’s dance. It self resolves within ❌ months.

ARF carditis is caused by an antibody & ❌ cell response against ❌ proteins and vascular cell adhesion molecule 1 (❌). Release of ❌ mediators cause tissue damage and remodelling. It can be ❌ but conversely resolution can occur with therapy, with no ❌ damage

Treatment of ARF
1. Hospitalisation for ❌ (Inflammatory markers, throat swab, anti-GAS serology, ECG, echocardiogram, chest x-ray)
There is no ❌ to begin treatment with ARF as there's no evidence to show it alters outcome of acute disease or heart damage.
- To treat GAS - Oral ❌ V (250mg two or three times daily for ❌ days)
- To treat arthritis – ❌
- To treat chorea, only if necessary – ❌
- To treat heart failure cardiac drugs may be necessary

Strategies to prevent ARF:
• Increase ❌ of rheumatic fever, what causes it and how to prevent it
• Reduce household ❌
• Improve ❌ to timely and effective treatment for strep throat
infections in ❌ communities