Rheumatic Fever: A Comprehensive Review

Author(s): Hong Yang

Rheumatic fever (RF) is a complex autoimmune inflammatory disorder triggered by inadequately treated group A Streptococcus (GAS) infections, primarily streptococcal pharyngitis. This review provides a comprehensive overview of RF, spanning its pathophysiology, clinical manifestations, diagnosis, treatment, and prevention strategies. RF's pathogenesis involves molecular mimicry between GAS antigens and host tissues, leading to immune-mediated damage primarily affecting the heart, joints, skin, and central nervous system. Clinically, RF presents with fever, migratory polyarthritis, carditis, subcutaneous nodules, and Sydenham's chorea. Carditis, characterized by valvulitis, is the most severe complication, with repeated episodes potentially resulting in rheumatic heart disease (RHD) and cardiac dysfunction. Accurate diagnosis relies on clinical criteria established by the Jones criteria, complemented by laboratory tests and echocardiography to assess cardiac involvement. Treatment goals include prompt antibiotic therapy to eradicate the streptococcal infection, symptom management with anti-inflammatory agents, and prevention of recurrences. Long-term antibiotic prophylaxis is imperative for individuals with a history of RF or RHD. In advanced RHD cases, cardiac surgery or valve replacement may be necessary. Preventing RF necessitates early diagnosis and treatment of streptococcal infections, reinforced by public health measures and improved healthcare access. Education campaigns promoting adherence to antibiotic regimens and awareness of RF's consequences are essential in reducing the global burden of this preventable but persistent disease.