Rheumatic arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

From the Arthritis Foundation

The term “rheumatic arthritis” is a misnomer.

Rheumatoid arthritis is the most common inflammatory form of arthritis and is discussed elsewhere on this website. “Rheumatic arthritis” may refer to rheumatic fever which causes a form of arthritis.

Acute rheumatic fever (ARF) is a complication of a strep throat caused by particular strains of strep. Although common in developing countries, ARF is rare in the United States, with small isolated outbreaks reported only occasionally. It is most common among children between 5-15 years of age.

A family history of ARF may predispose an individual to the disease. Symptoms typically occur 18 days after an untreated strep throat. An acute attack lasts approximately 3 months. The most common clinical finding is a migratory arthritis involving multiple joints.

The most serious complication is carditis, or heart inflammation (rheumatic heart disease), as this may lead to chronic heart disease, disability, or death years after an attack. Less common findings include bumps or nodules under the skin (usually over the spine) and a red rash on the trunk and extremities that recurs over weeks to months.

ARF may be difficult to diagnose because it has multiple presentations.

A neurological disorder, chorea, can occur months after an initial attack, causing jerky involuntary movements, muscle weakness, slurred speech, and personality changes. Initial episodes of ARF as well as recurrences can be prevented by treatment with antibiotics.

Scarlet fever is another possible cause of rheumatic fever.

The absence of any risk factors does not necessarily guard you against getting rheumatic fever.

Risk factors :

• Overcrowding
• Poverty
• Poor nutrition
• Dental surgery
• Family history

Symptoms seen with rheumatic fever include:

• Fever

• Appetite loss

• Malaise

• Joint symptoms

o Arthritis
o Arthritis-like symptoms
o Joint pain
o Swollen joints
o Warm joints
o Wrist joint symptoms
o Elbow symptoms
o Ankle symptoms
o Knee symptoms
o Often multiple joints affected

• Heart symptoms

o Heart murmur
o Heart inflammation
o Heart failure
o Edema
o Shortness of breath
o Weakness

Skin rash (Erythema marginatum)

• Abdominal pain

• Nervous system symptoms

o Chorea
o Spasms

Complications of rheumatic fever:

• Carditis
• Heart inflammation
• Chorea
• Rheumatic heart disease
• Chronic rheumatic heart disease
• Chronic heart disease
• Disability
• Death

Treatment for rheumatic fever:

• Bed rest
• Antibiotics
• Anti-inflammatory drugs
• Corticosteroids
• Hospitalization - for severe cases or heart symptoms
• Prophylactic antibiotics - during recovery to avoid recurrences

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