It is a systemic disease that primarily affects the heart and joints, which follows group streptococcal upper respiratory tract infections. It is characterized by five major manifestations like carditis, migratory polyarthritis, Syndenham’s chorea, subcutaneous nodules and erythema marginatum, and minor manifestations like fever arthralgia, elevated acute phase reactants, and prolonged PR interval on electrocardiography. Its cause is believed to be an immunologic reaction to group A streptococcal infection of the respiratory tract.

Diagnosis shall be based on the modified Jones criteria: either two major criteria, or one major criterion and two minor criteria,

PLUS

Evidence of an antecedent streptococcal infection (e.g, positive throat culture or rapid antigen test;

AND/OR

Elevated or increasing steptococcal antibody test. The modified Jones criteria need not be fulfilled in- patients presenting with Syndenham’s chorea, indolent carditis, and recurrence of acute rheumatic fever.

Treatment

Drug treatment:

Benzathine penicillin G I.M. 1.2 million units stat.

(For S/E, C/I, and D/I see under benzyl penicllin, page 39)

If patient is allergic to penicillin

Erythromycin, 250mg four times po daily for 10 days.

(For S/E, C/I, D/I and Dosage forms, see page 19)

PLUS

Aspirin, up to 2g four times daily for 4-6 weeks and gradually tapered over 2 weeks, (For S/E, C/I and Dosage forms, see page 33)