Jr. Carapetis et Bj. Currie, Rheumatic fever in a high incidence population: the importance of monoarthritis and low grade fever, ARCH DIS CH, 85(3), 2001, pp. 223-227
Aims-To describe the clinical features of rheumatic fever and to assess the
Jones criteria in a population and setting similar to that in many develop
ing countries.
Methods-The charts of 555 cases of confirmed acute rheumatic fever in 367 p
atients (97% Aboriginal) and more than 200 possible rheumatic fever cases f
rom the tropical "Top End" of Australia's Northern Territory were reviewed
retrospectively.
Results-Most clinical features were similar to classic descriptions. Howeve
r, monoarthritis occurred in 17% of confirmed non-chorea cases and 35% of u
nconfirmed cases, including up to 27, in whom the diagnosis was missed beca
use monoarthritis is not a major manifestation. Only 71% and 25% of confirm
ed non-chorea cases would have had fever using cut off values of 38 degrees
C and 39 degreesC, respectively. In 17% of confirmed non-chorea cases, anti
-DNase B titres were raised but antistreptolysin O titres were normal. Alth
ough features of recurrences tended to correlate with initial episodes, the
re were numerous exceptions.
Conclusions-Monoarthritis and low grade fever are important manifestations
of rheumatic fever in this population. Streptococcal serology results may s
upport a possible role for pyoderma in rheumatic fever pathogenesis. When r
ecurrences of rheumatic fever are common, the absence of carditis at the fi
rst episode does not reliably predict the absence of carditis with recurren
ces.