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PubMed1985

About five cases of acute rheumatic fever in the adult.

We describe five cases of acute rheumatic fever in adults (applying Jones's criteria and exclusion of other common causes of acute polyarthritis in adults). The polyarthritis was migratory in three patients and additive in two. Severe tenosynovitis was present in three patients. Only one patient had carditis and received corticoids. The others improved with aspirin. The disease subsided after a time period varying from one week to two months and did not relapse.

Adult↗

PubMed1992

The carditis/cardiomyopathy of rheumatic fever: relationship to pathogenesis.

Although the relationship between group A streptococcal upper respiratory tract infection and the development of acute rheumatic fever has been known for many years, the pathogenetic mechanism(s) have never been defined. Thus, the mechanism of damage to the valves and to the myocardium in patients with rheumatic fever remains unexplained. Traditionally, emphasis has been placed on the valvular damage in rheumatic heart disease, but there is considerable evidence for myocardial involvement. An abnormal immune response to some as yet unrecognized somatic or extracellular antigen of the group A streptococcus is probably related to the cardiomyopathy. This abnormal immune response is supported by considerable clinical and experimental evidence. Recent studies have suggested other mechanism to explain the myocardial damage including the influx of lymphocytes into the area as well as the possibility of damage relating to generation of oxygen-free radicals. As more sophisticated molecular biological studies of the group A streptococcus become available, perhaps the mystery of this very unique and common cardiomyopathy can be resolved.

Cardiomyopathies↗

PubMed1989

[Disorders of the system of hemostasis in patients with juvenile rheumatoid arthritis and rheumatic fever].

The investigation of haemostasis has been performed in 55 children aged 2 to 18 years suffering from juvenile rheumatoid arthritis (31 girls and 13 boys) and children suffering from rheumatic fever (7 girls and 4 boys). The results were compared with the control group of 25 healthy children. The minimal abnormalities has been found in the group of children with rheumatic fever in the investigated indices of haemostasis in the beginning of the disease as well as during treatment. In the group of children with juvenile rheumatoid arthritis the following abnormalities has been found: increased platelet count, fibrinogen, fibrinogen degradation products, fibrin, elongation of lysis time of the euglobulines, decrease of the plasminogen concentration.

Adolescent↗

PubMed1977

An analysis of the cost-effectiveness of pharyngitis management and acute rheumatic fever prevention.

The cost-effectivness of preventing primary acute rheumatic fever attacks by oral or benzathine penicillin treatment was analyzed for both epidemic and endemic streptococcal pharyngitis situations. Decision analysis was used: the probabilities and the outcome values were calculated from published data. Three penicillin strategies were compared: (A) treating only patients with group A streptococci-positive throat cultures; (B) treating all patients; (C) treating none of the patients. In the epidemic situation it is medically most effective and least costly to treat all patients with penicillin (Strategy B). In the endemic situation, Strategy B is also most cost-effective when oral penicillin is used in patient populations where the positive throat culture yield is at least 20%. Strategy A is optimal when the yield is between 5% and 20%; below a 5% yield, Strategy C is appropriate. For any individual patient, it is possible that choice of the most cost-effective treatment strategy could be based on the patient's clinical findings.

Cost-Benefit Analysis↗

PubMedDate not supplied

DRB1, DQA1, DQB1 genes in Turkish children with rheumatic fever.

OBJECTIVES: Several studies have suggested that genetic susceptibility to rheumatic fever (RF) may be linked to HLA Class II alleles. The purpose of this study was to examine the association between HLA Class II genes and RF in Turkish children. METHODS: DNA typing HLA Class II genes (DRB1, DQA1, DQB1) were performed in 55 children with RF and 50 healthy unrelated controls using sequence specific primers (SSP). RESULTS: The frequency of the HLA DQA1*03 (OR: 0.462, p < 0.05) allele was significantly decreased in the patient group. Also, the frequency of the combination of DRB1*04 and DQA1*03 allele (OR: 0.42, p < 0.01) was more significantly decreased in the patient group. Differences in frequencies of the DRB1 and DQB1 alleles between groups were not significant. CONCLUSIONS: Our data indicate that the HLA DQA1*03 allele may be a protecting factor in Turkish children with RF. Our results also suggest that the combination of the DRB1*04 and DQA1*03 alleles may be a stronger protective factor than the DQA1*03 allele alone.

Adolescent↗

PubMed1985

Clinical profile of rheumatic fever in some hospitalised children of Bangladesh.

Clinical profile of rheumatic fever (RF) in 100 hospitalised children of Bangladesh were studied. Peak age period of the incidence of the disease was found in the age group of 11-12 years (34 percent) and majority (83.5 percent) of the cases belonged to the middle and poor classes. There was slight preponderance of the male. Carditis was the commonest (64 percent) manifestation followed by poly-arthritis (51 percent). Chorea was present in 6 percent and subcutaneous nodules were in 7 percent cases. Erythema marginatum (EM) was conspicuous by its absence. Amongst the rheumatic heart diseases (RHD), mitral stenosis (MS) and mitral incompetence (MI) comprised the highest (35 percent) incidence and next to it was the MS (13 percent) and MI (9 percent).

Arthritis, Rheumatoid↗

PubMed1980

Streptococcal adherence to pharyngeal cells of children with acute rheumatic fever.

The adherence of strains of group A Streptococcus to pharyngeal cells from Egyptian children with acute rheumatic fever (RF) was examined. Nine RF-associated and eight unassociated streptococcal strains were tested in vitro for adherence to pharyngeal cells from 11 patients with acute RF and eight normal subjects. RF-associated streptococcal strains adhered more avidly to pharyngeal cells of patients with acute RF (mean, 11.8 bacteria/cell) than did unassociated strains (mean, 5.9 bacteria/cell; P less than 0.05). The difference in mean adherence could be attributed to certain RF-associated strains. There was no significant difference in adherence when pharyngeal cells from controls were used. Furthermore, one RF-associated streptococcal strain was found to adhere considerably more avidly to pharyngeal cells of patients with RF than to those of controls.

Adolescent↗

PubMed1992

[The results of a retrospective examination of patients with acute rheumatic fever].

The authors describe the results obtained during retrospective examinations of 45 subjects who suffered from acute rheumatic fever 10-14 years before. Of these, 19 subjects were treated with prednisolone in the acute disease period, 16 with indomethacin, and 8 subjects with voltaren. The examinations were mostly randomized (30 subjects); no differences in the anti-inflammatory effect were discovered. Heart disease was found in 9 persons (20%). Of these, 6 were treated with prednisolone, 2 with indomethacin, and 1 with voltaren. The disease relapses were recorded in 4 of them, the signs of valvulitis in the past were shown only by 2 persons (echocardiographically). 12 persons (27%) had mitral valve prolapse which had not been diagnosed on the first admission to the hospital, with any clinical signs of hypermotility lacking. In 18 persons (40%) having no valve lesions (disease, prolapse), an x-ray examination revealed a slight increase of the heart size, estimated as a manifestation of postmyocardial cardiosclerosis. Thus, it has been shown that modern anti-inflammatory therapy does not prevent the development of heart disease. Apparently, its onset is related to specific proneness in some of the patients.

Follow-Up Studies↗

PubMed2005

Review of 609 patients with rheumatic fever in terms of revised and updated Jones criteria.

BACKGROUND: To investigate the findings and prognosis of rheumatic fever (RF) patients seen in the past 20 years and to compare the last two decades. METHODS: The medical records of all RF patients admitted to Gazi University Department of Pediatric Cardiology during 1982-2002 were reviewed. The decade from 1.1.1982 to 31.12.1991 was designated as 1980s and the following decade as the 1990s. RESULTS: Among the 609 RF cases, there was no difference between the two decades regarding mean age, male/female ratio, most of the minor manifestations and findings of the preceding streptococcal infection. As the rate of carditis declined in 1990s, rates of arthritis and chorea increased. Severity of carditis and admissions with reactivation decreased during 1990s. The two decades did not differ regarding mean age, gender ratio, pericarditis rate, number and type of valvular involvement and sequel of carditis cases. Severity of carditis and number of valvular involvement influenced the first-year prognosis. Almost one-third of the arthritis cases had monoarthritis in both decades. Atypical cases with small-joint involvement were detected number of which increased during the 1990s. CONCLUSIONS: The two decades do not seem to differ regarding most of the manifestations of RF. More emphasis should be given to atypical cases such as small-joint involvement and monoarthritis and silent carditis.

Acute Disease↗

PubMed1952