Acute rheumatic fever diagnosis and management: Review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia

Abstract

Rheumatic fever (RF) is a common cause of acquired heart disease in children worldwide. It is a delayed, nonsuppurative, autoimmune phenomenon following pharyngitis, impetigo, or scarlet fever caused by group A β-hemolytic streptococcal (GAS) infection. RF diagnosis is clinical and based on revised Jones criteria. The first version of the criteria was developed by T. Duckett Jones in 1944, then subsequently revised by the American Heart Association (AHA) in 1992 and 2015. However, RF remains a diagnostic challenge for clinicians because of the lack of specific clinical or laboratory findings. As a result, it has been difficult for some time to maintain a balance between over- and underdiagnosis of RF cases. The Jones criteria were revised in 2015 by the AHA, and the main modifications were as follows: the population was subdivided into moderate- to high-risk and low risk; the concept of subclinical carditis was introduced; and monoarthritis was included as a feature of musculoskeletal inflammation in the moderate- to high-risk population. This review will highlight the major changes in the AHA 2015 revised Jones criteria for pediatricians and general practitioners.

Multisystem Inflammatory Syndrome in Children (MIS-C), a Post-viral Myocarditis and Systemic Vasculitis—A Critical Review of Its Pathogenesis and Treatment

“…These belong to a diverse family of pleiotropic and short-lived mediators generated from arachidonic acid moieties of the cell membrane and exert biological activities on many cell types including platelets and endothelial cells (143). ASA is the prototype non-steroidal anti-inflammatory drug (NSAID) that is also used in the treatment of rheumatic fever and KD (144,145). Traditionally, patients first receive high dose ASA followed by dose adjustment to exert a primarily antiplatelet effect upon resolution of fever.…”

Left atrial reverse remodeling improves sinus restoration following mitral valve replacement: A case report

“…Jones' criteria is one method of diagnosing acute rheumatic fever, requiring the presence of two major symptoms or one major symptom with two minor symptoms [12] . Confirmation of the patient's history of disease in search of possible rheumatic fever was required in this case [13] . Based on anamnesis, the patient was never diagnosed with acute rheumatic fever but had a history of high fever and joint pain causing difficulty walking as a teenager.…”

Prevalence of Rheumatic Heart Disease in Iran: A Systematic Review and Meta-analysis

“…According to the global map of low-and moderateto high-risk countries concerning RHD, Iran could not be categorized as a low-or moderate-to a high-risk population, i.e. due to the lack of reported literature on RHD (35). Accordingly, the lack of complete and accurate information at the national level prevents the adequate analysis of the RHD situation and determining distribution patterns.…”