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Rheumatic Fever
What tests are needed for rheumatic fever?
The examinations for rheumatic fever include laboratory tests and electrocardiograms, as well as imaging studies. Laboratory tests include indicators of streptococcal infection, commonly using throat swab bacterial cultures, which have a positivity rate of about 20% to 25%. They also include anti-streptolysin O tests, generally considered positive if the titer is above 1:400. Secondly, the tests include those for acute inflammatory response, common markers of which are elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Electrocardiograms help in detecting various arrhythmias, such as sinus tachycardia and prolonged PR interval. Echocardiography can be used to detect any abnormalities in the mitral valve of the heart.
Symptoms of rheumatic fever in children
Children often show symptoms of rheumatic fever, which commonly leads to myocarditis, arrhythmias, palpitations, and asthma. Additionally, there can be changes in the skin, such as subcutaneous erythema nodosum, as well as joint swelling and pain. There are also general symptoms like fever, fatigue, cough, nosebleeds, abdominal pain, nausea, and vomiting, along with swelling of the lymph nodes throughout the body. During examinations, there is often a significant increase in C-reactive protein and elevated levels of anti-streptococcal antibodies and anti-O. Abnormalities can also be seen on the electrocardiogram. Once symptoms of pediatric rheumatic fever appear, it is crucial to promptly visit a hospital for diagnosis and timely treatment.
What are the symptoms of rheumatic fever?
In the early stage of rheumatic fever, most patients show signs of infection, such as pharyngitis or tonsillitis. Patients with rheumatic fever often also experience fever, with body temperatures generally ranging from 38 to 40°C. Additionally, there may be migrating arthritis characterized by redness, swelling, warmth, pain, and limited mobility in the joints. Rheumatic fever patients may also suffer from cardiac valve lesions, primarily manifesting as valvulitis, myocarditis, or pericarditis, with damage to the valves being most common. Skin rashes, mainly presenting as ring-shaped erythema or subcutaneous nodules, can also occur. Some patients with rheumatic fever may experience chorea, which are among the primary symptoms of the condition.
Symptoms and Treatment of Rheumatic Fever
Patients with rheumatism often experience symptoms of upper respiratory tract infections in the early stages of the disease, such as fever and sore throat. Additionally, patients with rheumatism commonly exhibit migratory joint pain, primarily characterized by acute onset of redness, swelling, heat, pain, and limited mobility in the joints, but these can improve on their own. Patients with rheumatic fever often also suffer from carditis, which can include valvulitis, myocarditis, and pericarditis, with damage to the valves being the most common. Rheumatic fever may also present with ring-shaped erythema on the skin or subcutaneous nodules, and it can include chorea. The most common treatment for rheumatic fever is the intramuscular injection of penicillin. (Specific medication use should be carried out under the guidance of a doctor.)
How to test for rheumatic fever?
Rheumatic fever is a systemic connective tissue disorder occurring one to four weeks after an infection by Group A Streptococcus, primarily affecting the heart and joints, and commonly infects children and adolescents. The usual clinical manifestations include carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules, joint pain, and fever. Common laboratory tests for this disease include: 1. Complete blood count, often showing mild anemia and a slight increase in white blood cell count. 2. Elevated erythrocyte sedimentation rate. 3. Elevated C-reactive protein. 4. Antistreptolysin-O antibodies often greater than 500 units. 5. Positive throat swab culture. 6. Echocardiogram, which may show vegetations.
The difference between rheumatic fever and rheumatoid arthritis
The main difference between rheumatic fever and rheumatoid arthritis is that in addition to symptoms of arthritis, rheumatic fever also presents with elevated anti-streptolysin O levels and valvular heart disease, with some patients displaying subcutaneous erythema and chorea-like symptoms. Rheumatoid arthritis, on the other hand, primarily manifests as joint pain, and rarely involves heart valve issues. Additionally, rheumatoid arthritis is characterized by elevated rheumatoid factor, anti-CCP antibodies, and anti-AkA antibodies as its main clinical features. Patients with rheumatoid arthritis also exhibit increased inflammatory markers. The key differences between rheumatic fever and rheumatoid arthritis lie in the different antibodies involved and the general association of rheumatic fever with cardiac involvement.
The Difference Between Rheumatic Fever and Rheumatoid Arthritis
Most patients with rheumatoid arthritis primarily exhibit symptoms related to the joints. Mainly affected are the symmetrical small joints of both hands, including both wrists, both palmar digital joints, and both proximal interphalangeal joints. In addition, patients with rheumatoid arthritis often have elevated rheumatoid factor, anti-CCP antibodies, and AKA antibodies. During the acute phase of joint disease, there is a marked increase in inflammatory markers, which is a major manifestation of rheumatoid arthritis. Patients with rheumatic fever, aside from joint pain, may also have heart valve disorders, such as mitral stenosis, and some patients may develop skin lesions, commonly erythema nodosum. Most importantly, patients with rheumatic conditions often show a significant increase in anti-streptolysin O.
Can you soak your feet if you have rheumatic fever?
Patients with rheumatic fever can relieve some joint pain by soaking their feet, but this does not fundamentally solve the problem. Rheumatic fever is often caused by streptococcal infection, which leads to diseases such as arthritis. Therefore, antibiotics should be used at the source to eliminate streptococcal infection and hence prevent the recurrence of rheumatism. Additionally, we can use anti-inflammatory and analgesic drugs to control joint pain. Commonly used anti-inflammatory analgesics include non-steroidal pain relievers, such as diclofenac sodium sustained-release tablets. If there is inflammation in the heart due to rheumatic fever, corticosteroid treatment should be considered. (Medication should be used under the guidance of a doctor.)
Difference between Rheumatic Fever and Rheumatoid Arthritis
The key difference between rheumatic fever and rheumatoid arthritis primarily lies in the fact that patients with rheumatic fever, besides exhibiting symptoms such as joint pain, also develop cardiac and dermatological manifestations. Patients with rheumatic fever may experience mitral stenosis and symptoms like erythema on the skin. Moreover, the examination of antibodies in rheumatic fever patients mainly shows an elevation in anti-streptolysin O antibody. In contrast, patients with rheumatoid arthritis typically display elevated rheumatoid factor, anti-CCP antibodies, and anti-AKA antibodies, and they seldom have skin or cardiac manifestations. Therefore, to differentiate rheumatic fever from rheumatoid arthritis, one can test for anti-streptolysin O and rheumatoid factor, and further conduct an echocardiogram to determine any cardiac involvement.
Does rheumatic fever spread?
Firstly, rheumatic fever is a group of delayed sequelae caused by an infection of Group A Streptococci, simply put, it refers to a type of reactive arthritis that appears after an upper respiratory tract infection. It is associated with this streptococcus, and mostly occurs during the cold and humid seasons of winter and spring. It can affect people of any age, but is most commonly seen in children aged 5-14 and adolescents. Therefore, it is not a contagious disease, but rather a set of symptoms, such as fever and joint pain, appearing in individuals with weakened immune systems following an upper respiratory tract infection. Some people may even experience valvular heart disease. However, if treated actively in the early stages, the disease usually does not lead to any long-term consequences, unless it goes untreated or is treated under poor medical conditions, which may then result in rheumatic arthritis and rheumatic heart disease.