| • | occurs after group A beta-hemolytic strep pharyngitis |
Does not occur after strep impetigo: “The only way to a man’s heart, is through his pharynx”.
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| • | lab: elevated or rising antistreptolysin O (ASO) or antideoxyribonuclease B (anti-Dnase B) |
| • | 2 of the 5 major criteria are dermatologic… |
skin findings:
subcutaneous nodules (3-5% of patients):
| • | firm, non-tender, freely moveable, pea-sized |
| • | extensor surfaces of wrist, elbow, knees |
| • | scalp, over bony prominences of spinal column |
| • | their presence heralds severe carditis |
erythema marginatum (5-15% of patients):
| • | annular plaques with fairly distinct and serpiginous (raised) borders |
| • | accentuated by warm bath or hot towels |
| • | typically observed at peak activity of carditis and arthritis |
| • | ddx: Still’s disease, erythema infectiosum, livedo reticularis |
other:
migratory polyarthritis (85-95%)
| • | red, hot, swollen and exquisitely tender (patient will not tolerate even a bed sheet on an affected joint) |
| • | dramatic response to salicylates |
| • | validity of ARF diagnosis should be questioned with lack of resolution of arthritis 48-72 hours after initiation of therapy |
| • | does not result in chronic joint disease: “Rheumatic fever is a disease that licks the joints but bites the heart” |
ddx:
| • | juvenile RA, SLE, Lyme disease |
| • | septic arthritis (e.g. gonococcal) |
| • | post infectious reactive arthritides |
| • | myocarditis or pericarditis from other causes (e.g. coxsackie virus) |
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