The Problems in the Diagnosis of Acute Rheumatic Fever

Abstract

Because nosingle laboratory test or clinical finding that allows specific diagnosis of acute rheumatic fever ARF is available yet Jones criteriae described in 1 944 and have been revised and modified four times by the American Heart Association have been used worldwide to define and diagnose ARF Although the original aim of the Jones criteriae was to avoid misdiagnosis it has not been achieved to date completely especially in patients present with only one major manifestation i e polyarthritis The minor manifestations are so nonspecific and streptococcal infections are so frequent in the developing countries that ancillary requirements for diagnosis of ARF are easly fulfilled leading to overdiagnosis if there is one major manifestation that may be due to other disorders Furthermore leg pains functional heart murmurs and multiple tics have been misdiagnosed sometimes as ARF in the existence of high ASO titration On the other hand only echocardiography and streptococcal antibody tests that contributed new knowledge in the diagnosis of ARF have developed since original Jones criteria were published However echocardiography is not included properly into the last revision and update of Jones criteria in 1992 But echocardiographic studies in our clinical and during several outbreaks in the United States demonstrated silent valvular regurgitations in patients present with isolated arthritis or pure chorea The characteristic features of major manifestations of ARF which may be present alone and the proper usage of streptococcal antibody tests and Doppler echocardiography are discussed in this article in view of the medical literature and our clinical experiences Key words: Acute Rheumatic Fever

Keywords

• -

Akut Romatizmal Ateş Tanısında Karşılaşılan Zorluklar

Öz

SummaryBecause nosingle laboratory test or clinical finding that allows specific diagnosis of acute rheumatic fever ARF is available yet Jones criteriae described in 1 944 and have been revised and modified four times by the American Heart Association have been used worldwide to define and diagnose ARF Although the original aim of the Jones criteriae was to avoid misdiagnosis it has not been achieved to date completely especially in patients present with only one major manifestation i e polyarthritis The minor manifestations are so nonspecific and streptococcal infections are so frequent in the developing countries that ancillary requirements for diagnosis of ARF are easly fulfilled leading to overdiagnosis if there is one major manifestation that may be due to other disorders Furthermore leg pains functional heart murmurs and multiple tics have been misdiagnosed sometimes as ARF in the existence of high ASO titration On the other hand only echocardiography and streptococcal antibody tests that contributed new knowledge in the diagnosis of ARF have developed since original Jones criteria were published However echocardiography is not included properly into the last revision and update of Jones criteria in 1992 But echocardiographic studies in our clinical and during several outbreaks in the United States demonstrated silent valvular regurgitations in patients present with isolated arthritis or pure chorea The characteristic features of major manifestations of ARF which may be present alone and the proper usage of streptococcal antibody tests and Doppler echocardiography are discussed in this article in view of the medical literature and our clinical experiences Key words: Acute Rheumatic Fever

Anahtar Kelimeler

• -