Rheumatic fever

Rheumatic fever (RF) is a systemic inflammatory disease that develops as a complication of streptococcal infection, most often with pharyngitis or tonsillitis caused by group A β-hemolytic streptococcus. Rheumatic fever involves an immune hyperreaction to bacterial antigens, which leads to damage to various organs, including the heart, joints, skin, and central nervous system. Clinical manifestations of the disease can vary from mild carditis to severe valvular heart disease. The disease often occurs in children and adolescents, and its relapses can be observed with repeated infections of the system. The previous high prevalence of the disease in a number of countries indicates the need to control streptococcal infections and promptly treat them.

History of the disease and interesting historical facts

Rheumatic fever has been known since ancient times, although it was associated with heart disease as early as the 19th century. In the 1920s, scientists began to understand the connection between streptococcal infections and rheumatic fever, which became the basis for further medical research. Interestingly, in the 20th century, antibiotic prophylaxis was developed, which significantly reduced its prevalence in industrialized countries. References to rheumatic fever in literature date back to ancient Greek times, and in the 16th century, the famous physician Ambroise Paré wrote about this disease. Research shows that the immune response disorder is associated with hereditary factors, which only adds to the complexity of its understanding and treatment.

Epidemiology

Rheumatic fever remains a significant global disease, mainly affecting children and young adults aged 5 to 15 years. According to the World Health Organization, the incidence may reach 50 cases per 1,000 children in some low-income regions. There are significant differences in the prevalence of rheumatic fever depending on geographic location, level of economic development, and access to health care. In high-incidence countries, such as some countries in Southeast Asia and Africa, cases significantly exceed those reported in Europe and North America.

Genetic predisposition to this disease

Research suggests that some people have a genetic predisposition to developing rheumatic fever. Genetic markers associated with increased susceptibility include various polymorphisms in genes involved in the immune response. Examples of such genes include genes encoding major histocompatibility complexes (MHC) and genes responsible for cytokine production. Mutations in these genes can lead to an abnormal immune response to streptococcal infection and an increased likelihood of developing rheumatic fever. Research suggests that children with a history of rheumatic fever in their immediate family members have a significantly increased risk of developing the disease in the future.

Risk factors for the development of this disease

Rheumatic fever can develop under the influence of various risk factors, including:

• Genetic predisposition
• Frequent streptococcal infections (eg, sore throat or pharyngitis)
• Insufficient living conditions (overcrowded premises, poor hygiene)
• Low level of medical care and lack of vaccination
• Problems with access to antibiotics and their ineffective use

These factors taken together can increase the risk of developing LC, especially in areas with low economic conditions and a lack of prevention.

Diagnosis of this disease

Diagnosis of rheumatic fever is based on clinical manifestations and laboratory tests. The main symptoms include:

• Hemorrhagic or arthritic syndrome, with pain and swelling in the joints
• Symptoms of carditis such as shortness of breath and chest pain
• Skin rashes including erythematous nodules and exanthema migrans
• Nervous system symptoms such as chorea

Laboratory tests typically include streptococcal antibody levels (eg, ASO), inflammatory markers (C-reactive protein, rapid sedimentation rate). In addition, radiologic studies may include echocardiography to evaluate cardiac involvement. The differential diagnosis is important to exclude other conditions such as systemic lupus erythematosus, juvenile arthritis, and infective endocarditis.

Treatment

Treatment of rheumatic fever is based on suppressing the inflammatory process and preventing relapses. General measures include bed rest and a low-sodium diet. In pharmacological treatment, nonsteroidal anti-inflammatory drugs (NSAIDs) play an important role to control pain and inflammation. Antibiotics are also important to prevent relapse of streptococcal infection. In case of severe heart damage, surgical intervention, such as valve replacement, may be necessary. Other treatments may include physical therapy and rehabilitation to fully restore joint function and improve quality of life.

List of medications used to treat this disease

Medicines commonly used to treat rheumatic fever include:

• Penicillin (for the prevention of streptococcal infections)
• Aspirin and other NSAIDs (to relieve pain and inflammation)
• Corticosteroids (in case of severe carditis and systemic inflammation)
• Other immunosuppressive drugs (in severe clinical cases)

The choice of specific medications depends on the severity of symptoms and the presence of concomitant diseases.

Disease monitoring

Monitoring of a patient with rheumatic fever includes regular check-ups, laboratory tests, and cardiac evaluation. Control stages include examinations every three months during the first year after an episode of the disease and annual examinations in subsequent years. Prognosis depends on timely diagnosis and therapy; with adequate treatment, most patients can expect good results. However, complications such as chronic heart failure and repeated episodes of LF are possible, which require constant medical supervision.

Age-related features of the disease

Rheumatic fever is most common in children and adolescents. In younger children, the disease is more severe and has a greater number of complications. In adults, RL can manifest itself in the form of recurrent infections, but after 20 years of age, the risk is significantly reduced. Adults may have more hidden manifestations, which complicates diagnosis. Preventive treatment in this group should be more intensive to exclude cardiac changes.

Questions and Answers

• What causes rheumatic fever? Rheumatic fever occurs as a complication of streptococcal infection, most often as a result of sore throat or tonsillitis.
• How is rheumatic fever diagnosed? Diagnosis includes a clinical examination, tests for streptococci, and an assessment of the heart using ECG and echocardiography.
• What treatment is prescribed for rheumatic fever? Treatment includes antibiotics (eg, penicillin), nonsteroidal anti-inflammatory drugs, and, if needed, corticosteroids.
• What are the possible complications of rheumatic fever? Complications may include heart damage (carditis), repeated episodes of the disease, and the development of chronic heart failure.
• What is the prognosis for patients with rheumatic fever? The prognosis depends on timely diagnosis and treatment; in most cases, it is good if preventive recommendations are followed.