ACUTE RHEUMATIC-FEVER IN ADULTS - A RESURGENCE IN THE HASIDIC JEWISH-COMMUNITY

Objective. To describe a series of adults diagnosed with acute rheumat ic fever (ARF). Methods, Retrospective chart review of 14 patients age > 18 years with suspected ARF between 1990 and 1994 in a private rheu matology practice setting. Four additional patients treated at our med ical center were included in the study. Results. Twelve patients met J ones criteria for rheumatic fever and were included in the study. Of t hese, only 3 had a childhood history of rheumatic fever. Ail had recen t onset of arthritis and a history of antecedent sore throat. Only 4 p atients, however, had throat cultures positive for B-hemolytic strepto coccus. Nine patients were Hasidic Jews. Four patients had carditis. O ne patient had erythema marginatum, while chorea and subcutaneous nodu les were not seen. Nine patients improved taking nonsteroidal antiinfl ammatory drugs or acetylsalicylic acid; 3 required steroid treatment t o control severe arthritis. Conclusion. Our clinical experience sugges ts that ARF occurs frequently, especially among Hasidic Jewish adults. Due to the disabling nature of the arthritis and the significant inci dence (33%) of carditis, strict adherence to penicillin prophylaxis gu idelines is indicated.