Background
The objective of the study was to describe the clinical characteristics of atypical
articular presentations during the initial outbreak and recurrence in patients with
acute rheumatic fever (ARF) in the paediatric age group.
Methods
This was a retrospective, observational study conducted between January 2012 and December
2014 on all suspected cases of acute rheumatic fever (ARF) fulfilling either WHO 2004
or Australian guidelines with atypical articular manifestations ie, presence of at
least one of the following features: duration of symptoms more than 3 weeks; monoarthritis/arthralgia;
involvement of small joints of hand and feet and/or cervical spine and/or hip joint;
and, not responding to salicylates in 1 week.
Results
‘Atypical’ pattern was present in 63% (39/62) of patients with articular manifestations,
of which arthralgia was a common manifestation (57%). Polyarticular afflictions were
predominately non-migratory (additive) in both atypical (74%; 29/39) and typical (82%;
18/23) groups. Monoarticular (33%) affliction of the joints constituted a significant
disease manifestation. Time from onset to diagnosis was >3 weeks in 79% of patients
while small joints involvement and axial joint involvement occurred in half of the
cases (51%). Inadequate response to NSAIDs was found in three (7%) cases.
Conclusion
Atypical manifestations in ARF may well be mistaken for a connective tissue disorder,
post streptococcal reactive arthritis and septic arthritis. Physicians should be made
aware of these features to prevent diagnostic dilemma, and to effect institution of
appropriate management including penicillin prophylaxis
Keywords
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Article info
Publication history
Published online: April 24, 2017
Accepted:
March 14,
2017
Received in revised form:
January 2,
2017
Received:
June 9,
2016
Identification
Copyright
© 2017 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
