Rheumatic fever - RAA - Signs and symptoms

Acute articular rheumatism is a systemic disease, so patients may present with a variety of signs and symptoms. It is important to determine the form of strep throat or scarlet fever history of angina.General clinical picture includes fever, headache, rash, weight loss, epistaxis, fatigue, malaise, diaphoresis and pallor. Patients can experience pain in the chest or abdominal pain and vomiting, orthopnea.
For the diagnosis of rheumatic fever Jones criteria are used by the World Health Organization established in 1984 and revised in 1992.
Major criteria include:-Arthritis-CardChoree minor-Marginal erythema-Meynet, subcutaneous nodules.
Minor criteria include:-Arthralgia-FeverESR-accelerated-History of rheumatic feverC-reactive protein-Leukocytosis-Prolonged PR interval on EKG.
Presence of at least two major criteria or one major criterion and two minor criteria are indicators of high probability of acute rheumatic artricular if this poststreptococice recent signs of infection:Recent history of angina-strep or scarlet fever confirmedBeta-hemolytic streptococci, revealing the pharyngeal exudateASO-titre> 800 IU or streptozime positive test.
Major clinical manifestations.
Rheumatic arthritisRheumatoid is the most common manifestation is common in rheumatic fever onset-75%. Characteristic high artriculatiile arthritis begins in the lower extremities (ankle and knee) and migrate to other large joints of the upper or lower limbs (wrist, elbow). Affected joints are painful, swollen, warm, erythematous and limited mobilization. Arthritis reaches maximum severity within 12-24 hours and persists for 2-6 days.
Quick Reply to aspirin, symptoms and subtracting deminuind migrating to other joints. Rheumatoid is encountered and more severe in adults than in children and youth. Patients who have suffered numerous attacks strep-destructive arthritis may develop arthritis Jaccoud.
Rheumatic carditisPlacard is the most serious complication and the second after arthritis-50%. In advanced cases patients may experience shortness of breath, discomfortmoderate chest, pleuritic chest pain, edema, cough and orthopnea. Carditis is most commonly evidenced by the appearance of murmurs and tachycardia which does not correspond to the intensity of fever. Murmurs or modified newcomers are deemed necessary for the diagnosis of rheumatic valvulitei. Murmurs from the acute phase of disease arising in valvular regurgitation and those in chronic phase by valvular stenosis.
Card can be affirmed if Stollerman meet clinical criteria:-Emergent organic murmurs-CardiomegalyHeart-failure-Rubbing and / or pericardial exudate.
Congestive heart failure may develop after severe valvular insufficiency, or myocarditis. Clinical examination reveals tachypnea, orthopnea, jugular venous distention, rales, hepatomegaly, gallop rhythm and peripheral edema. Emphasizing a pericardial friction indicate pericarditis. Increased cardiac matitatii percussion, heart sounds are deafening and paradoxical pulse associated with pericardial tamponade.
Cardiac hemolytic anemia resulting from damage is by erythrocytes and platelets deformed valves.
Atrial arrhythmias are associated with chronic dilated left atrium through the mitral deformation. Successful cardioversion, especially if the patient is in fibrillation of less than 6 months, mitral stenosis is mild and not very dilated left atrium.
Sydenham Choreea or minor.In the absence of a family history of Huntington choree or signs of systemic lupus erythematosus, rheumatic fever diagnosis is certain in this choreei. There is a long latent period between streptococcal pharyngitis (1-2 months) and choreei installation. Patients with no shows and other criteria choree Jones usual. It is more common in women than in men. It is also known as St. Vitus dance.
Patients have difficulty in spoken and written language, grimacing, involuntary movements of the arms and legs choreiforme, generalized weakness and emotional lability. Physical signs include joint laxity, hypotonia, diminished tendon reflexes, fasciculations of the tongue (tongue worms).
Poststreptococice neuro-psychiatric changes.Children who have suffered several attacks of streptococcal infections shows an obsessive-compulsive syndrome characterized by somatic obsession and compulsive cleaning action, control changes with neurological deficits such as cognitive and motor hyperactivity. Onset is prepubertal and include emotional lability, separation anxiety and behavior of the opposition.
Erythema marginatum Annular erythema is known as a characteristic rash that occurs in 5-13% of patients. Macules and papules nepruriginoase begins by 1-3 cm in diameter, pink-red, located on the trunk and proximal limbs but also the face. The lesions are spreading intro serpingiforma manner as a ring with erythematous raised edges and pale center. Redness may diminish and reappears after several hours and is exacerbated by heat. Lesions persist long after resolution of streptococcal angina.
Aschoff subcutaneous nodules are infrequent manifestations of rheumatic fever, 0-8%. They appear on the extensor surfaces of elbows, knees, ankles and on the scalp and spinous processes of lumbar and thoracic vertebrae. Are firm, painless and mobile, with dimensions of 1-2 cm. Vary in number from one up to tens.Histologically areas of concentration are observed in the heart Aschoff body. They usually occur every couple of weeks in the disease and evolve for a month. Are associated with severe rheumatic carditis.
Abdominal pain usually occurs after the onset of rheumatic fever. It is due to mesenteric microvascular inflammation may mimic acute appendicitis and acute.