UMEM Educational Pearls

Category: Pediatrics

Title: Rheumatic Fever

Keywords: Rheumatic Fever, Jones Criteria, Heart Disease, Salicylates, Chorea (PubMed Search)

Posted: 11/9/2007 by Sean Fox, MD (Updated: 10/14/2019)
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Rheumatic Fever

  • Significant cause of cardiovascular morbidity in developing countries and still present in the USA, although declining in incidence.
  • American Heart Association update of the Jones Criteria (1992):
    • Major Criteria
      (1)    Carditis (of any of the layers of the heart)
      (2)    Polyarthritis
      (3)    Subcutaneous Nodules
      (4)    Erythema Marginatum
      (5)    Chorea
    • Minor Criteria
      (1)    Arthralgia (not a criterion if polyarthritis is present)
      (2)    Fever
      (3)    Elevated acute-phase reactants (ESR, CRP)
      (4)    Prolonged P-R interval
  • Diagnosis made by presence of TWO MAJOR or ONE MAJOR PLUS TWO MINOR.
  • Diagnosis can also be made with presence of chorea and documented strep pharyngitis.
  • Acute Management
    • Treat the Infection
      (1)    Penicillin (Pen V for 10 days or Pen G IM)
    • Alleviate Symptoms
      (1)    Salicylates are particularly effective for migratory arthritis
      (2)    High Dose ASA (80-100mg/kg/Day for several weeks, and then taper)
      (3)    NSAIDs for those who cannot tolerate ASA
      (4)    Steroids reserved for moderate to severe carditis.