RHEUMATIC FEVER

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RHEUMATIC FEVER

Ques. 1     Describe Rheumatic fever?

Ans.          Rheumatic fever is an acute disease marked by fever, joint pains and liability to carditis.

  • Age – common in lower age group (5 to 15 years). Family history may be present.
  • Sex – mostly females in childhood, males latter.
  • Causes - The exact cause is unknown. The associate factors are –
  • Climate – Chiefly in temperate climate.
  • Social history – usually lower income group.

Preceded by upper respiratory infection, tonsillitis, pharyngitis etc. – Due to overcrowding, bad sanitation etc.

Ques. 2     What is the pathology of Rheumatic fever?

Ans.          Rheumatic fever is a general infection which can permanently damage the valves of heart, the myocardium and pericardium may also be affected. The joints are swollen in acute stage of the illness but the effect is temporary. Hence the old age, ‘Rheumatic fever licks joints but bites the heart’.

Ques. 3     What are the clinical features, signs and symptoms?

Ans.          Clinical Features : Symptoms –

  1. Epistaxis may be present,
  2. Fleeting like pains.
  3. Onset may be sudden with pain, swelling and stiffness in one or more joints.
  4. Fever, sweating with fatigue, malaise and loss of weight, anorexia, furred tongue. Constipation and proteinurea.

Signs –

  1. Erythema marginatum –irregular, elevated reddish patches seen over the trunk.
  2. Temperature, sweating and tachycardia.
  • Rheumatic nodules may be present in children.
  1. Pancarditis, retrosternal or precordial pain and pericardial friction may be heard. An effusion may be present.
  2. Fleeting polyarthritis (chiefly large joints, no residual damage).
  3. Choreiform movements of multiple joints.
  • Purpura may also be present.
  • History of streptococcal infection (e.g.tonsillitis) may be present.
  1. Swelling of joints, e.g. knees, ankles, shoulders, wrists etc. – tender on palpation.

Diagnosis : A patient may be diagnosed clinically as a case of Rheumatic fever, if 3 of the following 10 manifestations are present provided that at least one of them is major-

Major Manifestations –

  1. Inflammation of joints (arthritis).
  2. Subcutaneous (rheumatic) nodules.
  3. Definite past history of rheumatic fever.
  4. Signs of active carditis.

Minor Manifestations :

  1. Praecordial pain.
  2. Abdominal pain.
  • Purpura.
  1. Fever.
  2. Erythema marginatum.

Investigations :

  1. Increased antistreptolysin ‘O’ titre.
  2. Increased C-reactive protein.
  3. C.G. is abnormal.
  4. X-ray of chest often shown enlarged cardiac shadow.
  5. Blood-Polymorphonuclear leucocytosis.
  6. S.R. is high.

Differential Diagnosis :

  1. Still’s disease.
  2. Traumatic arthropathy.
  • Haemophilic joint and Henoch-schonlein purpura.
  1. Systemic lupus erythematosus.
  2. Subacute bacterial endocarditis.
  3. Osteomyelitis.
  • Acute suppurative arthritis.

Complications :

  1. Hyperpyrexia.
  2. Delirium.
  • Chorea.
  1. Erythema, purpura.
  2. Myocarditis, endocarditis, pericarditis.
  3. Bronchopneumonia, Pleurisy.

Ques. 4     What is the treatment of Rheumatic fever?

Ans.          Treatment :

  1. Treatment of cause.
  2. Periodical check-up is also essential for prevention of relapse.
  3. Diet-During the active stage, should be liquid only, containing is dextrose, milk and fruit juices; semisolid are allowed when convalescence is nearing.
  4. Gradual resumption of activities over months.
  5. Complete bed rest till – (i) temperature in normal, (ii) no evidence of active carditis.
  6. Homoeopathic Remedies –

1) Pulsatilla : Not much swelling or redness of the affected parts. Pains which shift rapidly from one part to another. Sensation of weight in disordered structure. Persons of a mild, tearful disposition.

2) Bryonia : Stiffness, with swelling and a faintish redness of inflamed part. Stitching, worse from least motion. Dry, hot skin; bitter taste, dry mouth and great thirst. Hard dry stools.

3) Cactus Gr. : Heart were grasped with an iron hand, which grasps and relaxes alternately. Oedema and a quick throbbing tense, hard pulse which may or may not intermit.

4) Ledum : Rheumatic pains in the lower extremities, esp. in the hip and when it commences from below and goes upwards ; worse in the evening in bed.

5) Rhus Tox : Swelling and redness of affected parts. Pains drawing tearing, burning, or as if sprained, with sensation of lameness and creeping in parts. Pains worse during rest & when first commencing to move. Better from continued motion and external warm applications.

Ques. 5     Which Biochemic Remedies are important?

Ans.          Biochemic Remedies : -

1) Natrum Phos : Characterized by yellow-coated tongue, acid symptoms, or where there is a scrofulous basis. Rheumatic pains in the joints, with profuse sour-smelling sweat. It acts upon uric acid of the cells and renders it harmless. “Great stiffness & cracking of joints. Worse towards evening”.

2) Ferrum Phos. : Acute articular rheumatism, which is very painful; when any movement sets up pain or tends to increase it; especially of the shoulder; pains extend to upper part of chest. Worse on motion; better by warmth.

3) Calcarea Phos.: Rheumatism of the joints with cold or numb feeling, creeping feeling in parts affected. Numbness, lameness. Every cold brings on rheumatic pains in joints. Worse with every change of weather.

4) Kali Mur. : Second stage of rheumatic fever, when exudation takes place around the joints. This remedy removes swelling by restoring the non-functional cells of excretory and absorbing structures to normal action. White or gray-furred tongue.

Prevention of Recurrence

  • Penicillin and sulphonamides to prevent throat infection.
  • Prolonged salicylate or substitute in adequate doses.
  • Adequate bed rest
  • Prompt attention of foci of infection.

Differential Diagnosis :

Acute Rheumatic Fever

Acute Gout

(1)

Usually young adult.

Middle age or above.

(2)

Large joints are affected.

Small joints are affected.

(3)

Pain wonders from joint to joint.

Pain localized.

(4)

Swelling hot and pale.

Swelling red and tense.

(5)

Pain on pressure or movement.

Pain persist even at rest.

(6)

No tophi in ears.

Tophi in ears.

(7)

High continued temperature.

Temperature slight.

(8)

Heart affection present.

No heart affection.

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