Clinical Findings and Vitamin D Levels in Children with Acute Rheumatic Fever

Abstract

Objective: Acute rheumatic fever (ARF) is an autoimmune disease and the leading cause of acquired heart disease in children living in low- and middle-income countries. Vitamin D deficiency has been reported in various autoimmune diseases. In this study, our objective was to assess clinical, laboratory and echocardiographic findings of patients with ARF, and to evaluate patients for vitamin D deficiency. Materials and Methods: In this retrospective study spanning 21 years, children diagnosed with ARF and followed up were evaluated. Among them, patients whose vitamin D levels were measured at the time of diagnosis were compared with a healthy control group. Results: Of the 244 patients included in the study, 116 (47.5%) were female, and 128 (52.5%) were male. Patients' mean (SD) age was 10.1 (±3.0) years. Recovery or regression of valve insufficiency was observed in 95 (46.3%) out of 205 patients with carditis. The sensitivity of the Jones Criteria increased from 86.5% to 95.5% with the last update. Among the 34 patients in whom vitamin D levels were measured, 91.2% of them were found to have deficient or insufficient levels. The median (IQR) vitamin D level was 10.0 (8.7) ng/mL in the patient group and 16.2 (8.9) ng/mL in the control group, with a statistically significant difference (P = .002). Conclusion: Regular secondary prophylaxis may contribute to the improvement of valvular findings. The last revision of the Jones Criteria has increased diagnostic sensitivity in ARF. Vitamin D deficiency may play a role in the pathogenesis of the disease.

Keywords

• Autoimmunity
• Child
• Jones criteria
• Rheumatic fever
• Vitamin D

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