Clinical Review

Rheumatic fever and its management

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39031.420637.BE (Published 30 November 2006) Cite this as: BMJ 2006;333:1153
  1. Antoinette M Cilliers, consultant
  1. 1Division of Paediatric Cardiology, C H Baragwanath Hospital, PO Box 2588, Northcliff, 2115, Johannesburg, South Africa
  1. amcilliers{at}icon.co.za
  • Accepted 8 November 2006

The diagnosis of acute rheumatic fever is a clinical challenge and depends on the possibility of the disease being borne in mind. Although the complete eradication of rheumatic fever from the Western world has not been achieved, the disease is often forgotten in the differential diagnosis of a patient with fever and polyarthralgia or arthritis. Rheumatic fever remains an important acquired cardiac disease in low and middle income countries and among poorly resourced communities in high income countries. Rheumatic heart disease places a heavy economic burden on the healthcare system in low and middle income countries because of the costs of medical treatment and heart valve surgery and also because it is a disease of young adults, who are the most economically active group of any population. Management is complex and involves different levels of care. The only new advances in the management of acute rheumatic fever to date are in the development of vaccines.

Summary points

  • Rheumatic heart disease is a major cause of morbidity and mortality in low and middle income countries and among underprivileged communities in high income countries

  • Primary prevention of acute rheumatic fever requires adequate antibiotic treatment of streptococcal throat infections

  • Secondary prevention entails prevention of recurrent episodes of acute rheumatic fever and is the most effective way of preventing rheumatic heart disease

  • Corticosteroids do not reduce the risk of developing heart valve lesions after one year

  • Surgery may be a life saving measure in patients with acute rheumatic fever and major valve lesions

Sources and search criteria

  • Modern management strategies for rheumatic fever were sourced from PubMed publications, 2000-6

  • Search terms included “acute rheumatic fever”, “rheumatic heart disease”, “management”, and “treatment”

  • Systematic Cochrane reviews provided the evidence for primary and secondary prophylaxis and anti-inflammatory treatment of acute carditis in patients with acute rheumatic fever

  • Additional references were identified through reviewed …

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