Current guidelines for the treatment of patients with rheumatic fever

Rheumatic fever is a multisystem inflammatory disease that occurs as a dela yed sequelae to group A streptococcal pharyngitis, The important clinical m anifestations are migratory polyarthritis, carditis, chorea, subcutaneous n odules and erythema marginatum occurring in varying combinations. The patho genesis of this disorder remains elusive: an antigenic mimicry hypothesis b est explains the affliction of various organ systems after a lag period fol lowing pharyngeal infection. In its classic milder form, the disorder is la rgely self-limited and resolves without sequelae, but carditis may be fatal in severe forms of the disease. Chronic and progressive damage to the hear t valves leads to the most important public health manifestations of the di sease. Anti-inflammatory agents provide dramatic clinical improvement, but do not prevent the subsequent development of rheumatic heart disease. The r ole of corticosteroids in treatment of carditis is uncertain and controlled studies have failed to demonstrate improved long term prognosis, Chorea, o nce considered a benign self-limited disease, is now felt to require more a ggressive treatment, in particular with sedatives. Prevention of first and subsequent attacks of rheumatic fever is the mainstay in the limited arsena l available to alter the natural history of this disease.