Diagnosis and management of acute rheumatic fever

Irma Kartika (1), Syafarinah Nur Hidayah Akil (2)
(1) Universitas Muhammadiyah Surabaya,
(2) Universitas Muhammadiyah Surabaya, Indonesia


Acute rheumatic fever is a nonsuppurative, immune-mediated consequence of group A streptococcal pharyngitis. Recurrent or severe acute rheumatic fever can cause permanent cardiac valve damage and rheumatic heart disease. Universally, the most common major manifestations during the first episode of ARF remain carditis and arthritis. Subclinical carditis now can fulfils a major criterion for ARF in all populations as in revised Jones criteria – AHA 2015. Many of the clinical features of ARF are non-specific, so a wide range of differential diagnoses should be considered. Primary prevention requires accurate recognition and proper antibiotic treatment of GAS pharyngitis. Prevention of recurrent attacks of rheumatic fever (secondary prevention) is the most cost-effective way of preventing further rheumatic heart disease (RHD). Penicillin remains the antibiotic of choice. Intramuscular penicillin is preferred as it is more effective than oral penicillin and results in better compliance.

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Al-Jazairi, A., Al-Jaser, R., Al-Halees, Z., Shahid, M., Al-Jufan, M., Al-Mayouf, S., Al-Rajhi, A., & Al-Hajjar, S. (2017). Guidelines for the secondary prevention of rheumatic heart disease. International Journal of Pediatrics & Adolescent Medicine, 4(1), 47–50. https://doi.org/10.1016/j.ijpam.2017.02.002

Arabaci, Ç., & Ak, K. (2020). Beta hemolytic Streptococci strains isolated from clinical specimens, their characteristics and antibiotic susceptibility. Journal of Surgery and Medicine. https://doi.org/10.28982/josam.672119

Auala, T., Zavale, B. G., Mbakwem, A. Ç., & Mocumbi, A. O. (2022). Acute Rheumatic Fever and Rheumatic Heart Disease: Highlighting the Role of Group A Streptococcus in the Global Burden of Cardiovascular Disease. Pathogens, 11(5), Article 5. https://doi.org/10.3390/pathogens11050496

Barik, R. (2018). Secondary prophylaxis to control rheumatic heart disease in developing countries: Put into a cage if can’t be killed. Indian Heart Journal, 70(6), 907–910. https://doi.org/10.1016/j.ihj.2018.01.001

Brouwer, S., Rivera-Hernandez, T., Curren, B. F., Harbison-Price, N., De Oliveira, D. M. P., Jespersen, M. G., Davies, M. R., & Walker, M. J. (2023). Pathogenesis, epidemiology and control of Group A Streptococcus infection. Nature Reviews Microbiology, 21(7), Article 7. https://doi.org/10.1038/s41579-023-00865-7

Carapetis, J. R., Steer, A. C., Mulholland, E. K., & Weber, M. (2005). The global burden of group A streptococcal diseases. The Lancet. Infectious Diseases, 5(11), 685–694. https://doi.org/10.1016/S1473-3099(05)70267-X

Cilliers, A. M. (2006). Rheumatic fever and its management. BMJ : British Medical Journal, 333(7579), 1153–1156. https://doi.org/10.1136/bmj.39031.420637.BE

Cunningham, M. W. (2000). Pathogenesis of Group A Streptococcal Infections. Clinical Microbiology Reviews, 13(3), 470–511.

Gerber, M. A., Baltimore, R. S., Eaton, C. B., Gewitz, M., Rowley, A. H., Shulman, S. T., & Taubert, K. A. (2009). Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation, 119(11), 1541–1551. https://doi.org/10.1161/CIRCULATIONAHA.109.191959

Gewitz, M. H., Baltimore, R. S., Tani, L. Y., Sable, C. A., Shulman, S. T., Carapetis, J., Remenyi, B., Taubert, K. A., Bolger, A. F., Beerman, L., Mayosi, B. M., Beaton, A., Pandian, N. G., & Kaplan, E. L. (2015). Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography. Circulation, 131(20), 1806–1818. https://doi.org/10.1161/CIR.0000000000000205

Kaplan, E. L. (2005). Pathogenesis of acute rheumatic fever and rheumatic heart disease: Evasive after half a century of clinical, epidemiological, and laboratory investigation. Heart, 91(1), 3–4. https://doi.org/10.1136/hrt.2004.034744

Katzenellenbogen, J. M., Ralph, A. P., Wyber, R., & Carapetis, J. R. (2017). Rheumatic heart disease: Infectious disease origin, chronic care approach. BMC Health Services Research, 17, 793. https://doi.org/10.1186/s12913-017-2747-5

Kumar, R. K., Antunes, M. J., Beaton, A., Mirabel, M., Nkomo, V. T., Okello, E., Regmi, P. R., Reményi, B., Sliwa-Hähnle, K., Zühlke, L. J., Sable, C., & null, null. (2020). Contemporary Diagnosis and Management of Rheumatic Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart Association. Circulation, 142(20), e337–e357. https://doi.org/10.1161/CIR.0000000000000921

Kumar, R. K., & Tandon, R. (2013). Rheumatic fever & rheumatic heart disease: The last 50 years. The Indian Journal of Medical Research, 137(4), 643–658.

Madiyono, B. (1998). Pediatric Cardiology in The Past, Present, and Future: Its Role in The Prevention and Management of Cardiovascular Disease. Paediatrica Indonesiana, 38(1–2), 1–19. https://doi.org/10.14238/pi38.1-2.1998.1-19

Maryland, V. W., RPh Consultant Pharmacist Rockville. (2020). Preventing Rheumatic Heart Disease. https://www.uspharmacist.com/article/preventing-rheumatic-heart-disease

Ralph, A. P., Noonan, S., Wade, V., & Currie, B. J. (2020). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. Medical Journal of Australia, 214(5). https://www.mja.com.au/journal/2021/214/5/2020-australian-guideline-prevention-diagnosis-and-management-acute-rheumatic

Reményi, B., Wilson, N., Steer, A., Ferreira, B., Kado, J., Kumar, K., Lawrenson, J., Maguire, G., Marijon, E., Mirabel, M., Mocumbi, A. O., Mota, C., Paar, J., Saxena, A., Scheel, J., Stirling, J., Viali, S., Balekundri, V. I., Wheaton, G., … Carapetis, J. (2012). World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease—An evidence-based guideline. Nature Reviews. Cardiology, 9(5), 297–309. https://doi.org/10.1038/nrcardio.2012.7

Seckeler, M. D., & Hoke, T. R. (2011). The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clinical Epidemiology, 3, 67–84. https://doi.org/10.2147/CLEP.S12977

Sudeep, D. D., & Sredhar, K. (2013). The Descriptive Epidemiology of Acute Rheumatic Fever and Rheumatic Heart Disease in Low and Middle-Income Countries. American Journal of Epidemiology and Infectious Disease, 1(4), Article 4. https://doi.org/10.12691/ajeid-1-4-2

WHO. (2004). Rheumatic fever and rheumatic heart disease: Report of a WHO expert consultation, Geneva, 29 October - 1 November 2001. World Health Organization. www.who.int/ cardiovascular diseases/resources/trs 923/en

WHO. (2020). Rheumatic heart disease. Rheumatic Heart Disease. https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease

Woldu, B., & Bloomfield, G. S. (2016). Rheumatic Heart Disease in the Twenty-First Century. Current Cardiology Reports, 18(10), 96. https://doi.org/10.1007/s11886-016-0773-2


Irma Kartika
irma.cardio@gmail.com (Primary Contact)
Syafarinah Nur Hidayah Akil
Author Biographies

Irma Kartika, Universitas Muhammadiyah Surabaya


Syafarinah Nur Hidayah Akil, Universitas Muhammadiyah Surabaya

Kartika, I., & Akil, S. N. H. (2023). Diagnosis and management of acute rheumatic fever. Qanun Medika - Medical Journal Faculty of Medicine Muhammadiyah Surabaya, 7(2). https://doi.org/10.30651/jqm.v7i2.19023

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