Rheumatic Inflammation

Rheumatic fever (morbus rheumaticus) is an immune system disorder classified as a systemic disease. It is one of the most common complications following tonsillitis or other inflammatory conditions of the throat caused by group A streptococcus bacteria. This type of fever is among the leading causes of heart defects in children and adolescents. As noted by the French physician Ernest Charles Lasègue: "Rheumatic fever attacks the joints and damages the heart".

Rheumatic fever is a post-streptococcal complication of pharyngitis, with a distinct pathogenesis. Upon exposure to streptococcal bacteria, the body initiates antigen production. This triggers an immune-mediated hormonal response, leading to autoimmunity against native cells. Over time, inflammatory lesions develop in the heart and vasculature, resulting in cellular infiltrates. These infiltrates, termed Aschoff bodies, subsequently undergo necrosis and fibrosis.

The clinical manifestations of rheumatic fever typically emerge approximately three weeks following an untreated streptococcal pharyngeal infection. However, the latent phase of the disease may extend for several years. The usual duration is 4–6 weeks. The symptoms of this condition have been categorized into minor and major criteria. To establish a diagnosis of rheumatic fever, at least two major criteria or one major and two minor criteria must be present. Minor criteria include: fever, a history of rheumatic disease, elevated antistreptolysin O (ASO) titers exceeding 200 units, arthralgia, prior streptococcal infection, elevated white blood cell count and erythrocyte sedimentation rate (ESR) in blood tests, and the presence of acute-phase reactants, such as elevated C-reactive protein (CRP) levels. Major criteria encompass: subcutaneous nodules, carditis, migratory polyarthritis, the presence of erythema marginatum, and Sydenham's chorea, which predominantly affects children and is characterized by involuntary choreiform movements, emotional disturbances, and hyperactivity.

The management of rheumatic fever primarily involves antibiotic therapy, with penicillin serving as the primary treatment for combating the condition. Physicians frequently recommend the use of non-steroidal anti-inflammatory drugs for patients. In acute cases, corticosteroids are administered to alleviate symptoms. Additionally, reducing physical activity and ensuring adequate rest are crucial components of symptomatic care.