Diagnosis of Rheumatic Fever (RF)

The diagnosis of RF at times becomes difficult, especially when the various clinical manifestations occur either independently, or in varied combinations. In such a situation, other points need to be considered, like presence of fever, pain in joints (arthralgia) i.e. when typical painful swollen joints were not present in the patient earlierar any of the manifestations of RF /RHD. Some laboratory tests may also aid in the diagnosis like ECG, and various blood tests like raised erythrocyte sedimentation rate (ESR), presence of C-reactive protein and raised leucocyte count (leucocytosis).

The above-mentioned are only minor criteria for the diagnosis of the RF. The major criteria for diagnosing RF remain the painful swelling of various joints (polyarthritis), involvement of heart (when on examination the physician finds murmurs, pericardial rub or signs of pericardial effusion i.e. fluid in the pericardial cavity surrounding the heart), including other major clinical features of the disease like rheumatic chorea/nodules, erythema marginatum, described earlier.

If anyone of the above-mentioned major criteria is present in a patient, and it is associated with any two of the minor criteria, the patient is in rheumatic activity, and needs urgent treatment. Alternatively, if the patient has the two major criteria, with or without any minor criteria, an acute stage of the disease should be considered.

The idea is that early diagnosis should not be missed in any case, and the patient, if an adult, or the parents of the child, should be careful enough to keep the physician in touch with the various symptoms of RF.

In addition to the above criteria, if in a patient some evidence of infection of the specific organism, i.e. group A streptococcus is available, that further helps in diagnosis, and therefore, blood examination for antibodies to streptococci, or a throat culture may be carried out, if possible. However, there are no precise tests for the diagnosis of RF, and it is only through the overall clinical picture and a few general tests that the diagnosis can be reached. Other tests, like echocardiography, radiographs may also be required, depending upon the case.

Why is early diagnosis vital?

The most severe complication of the recurrence of various attacks of RF is that the heart may be damaged permanently, called chronic RHO, requiring surgical intervention to improve the functioning of the heart. The other manifestations of RF like involvement of joints etc., disappear completely even if the disease is recurrent. It may look astonishing to the readers that the joints which become adversely affected as a result of the disease, making the child/adult incapacitated, on recovery, become perfectly normal without any sign of impairment left in the joints. But this may not happen so far as the heart is concerned. Each attack of RF may damage the heart, and this damage may be added during each recurrence of the disease. One may say in a lighter vein that the disease only frightens the joints, but severely beats/damages the heart.

The prevention of RHO lies in the early diagnosis and treatment of acute RF. In the heart, it is the valves that are permanently damaged, as a result of recurrent allergic effects on the valves. Once the patient has been properly diagnosed, further attacks of RF /RHO can be prevented by the prophylactic use of antibiotics for sore throat, and hence saving the heart from permanent damage.