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Rheumatic Fever: Assessment, Analysis, and Associated Dental Management Guidelines

RHEUMATIC FEVER FACTS AND OVERVIEW

Rheumatic fever (RF) is a nonsuppurative acute inflammatory response to a previously untreated or partially treated Group A, β hemolytic streptococcus infection.

Patients with a diagnosis of RF will give a history of having had strep throat or scarlet fever a few weeks prior to the start of the symptoms and signs associated with RF. RF can occur within three to four weeks of an infection with β hemolytic streptococcus. The prevalence rate of RF following an untreated or incompletely treated β hemolytic infection is 3%.

RF is thought to be an abnormal immune-system response to the streptococcal antigens, streptolysin O and streptolysin S. Streptolysin O is strongly antigenic and triggers the production of antistreptolysin-O antibody (ASLO). The presence of high levels of ASLO during the acute phase of RF confirms the likelihood of the condition. The RF-triggered antigen–antibody cross-reactivity affects the periarteriolar connective tissue, targeting the heart, joints, skin, and neurological tissues.

Note that acute RF is associated with a negative throat culture because it occurs a few weeks after a β hemolytic streptococcus infection.

The Major and Minor Jones Criteria

The Major and Minor Jones Criteria, established in 1944, help with the diagnosis of RF.

Major Jones Criteria

The Major Jones Criteria for RF are polyarthritis, carditis, rheumatic chorea, erythema marginatum, and erythema nodosum.

Arthritis

Major joints, when affected, are involved bilaterally with an aseptic arthritis. The joints swell and become extremely painful. Recovery of one set of joints is associated with involvement of another set of joints. Once recovery occurs, there is no residual joint deformity.

This type of arthritis is called fleeting polyarthritis because of the moving pattern of joint involvement. The polyarthritis is aggressively treated with pain medications until resolution occurs within a few weeks. Rheumatic arthritis is commonly seen in children.

Carditis

RF can affect all three layers of the heart. The endocardium is the most frequently affected layer. Fibrosis of the valves can lead to stenosis (narrowing) or incompetence (widening).

When the blood passes through a stenosed valve, it causes turbulence in blood flow, resulting in a heart murmur. With valvular incompetence, the blood regurgitates back into the heart chamber abov/>