Master Rheumatic Fever with Picmonic for Physician Assistant

Rheumatic fever is an immunologically mediated inflammatory disease that typically develops two to three weeks after an episode of group A streptococcal pharyngitis due to antibodies directed against the M proteins of streptococci that cross react with self antigens in the heart.

Rheumatic fever is an immunologically mediated inflammatory disease that typically develops two to three weeks after an episode of group A streptococcal pharyngitis. Acute carditis can occur and may progress over time to chronic rheumatic heart disease, commonly with valvular abnormalities.

In rheumatic heart disease, distinctive lesions occur in the heart called Aschoff bodies which are foci of primarily T lymphocytes, occasional plasma cells, and enlarged activated macrophages called Anitschkow cells. During acute rheumatic fever, Aschoff bodies and diffuse inflammation can be found in any of the layers of the heart.

Anitschkow cells are plump activated macrophages that have abundant cytoplasm and central round nuclei that may become multinucleated. They have an ovoid nucleus and chromatin that is condensed toward the center of the nucleus in a wavy rod-like pattern that to some resembles a caterpillar. Anitschkow cells are pathognomonic for rheumatic fever.

Typically, death in acute rheumatic fever is caused by myocarditis, which can cause pericardial friction rubs, weak heart sounds, tachycardia, and arrhythmias. Myocarditis can also cause cardiac dilation and can evolve to a functional mitral valve insufficiency or fulminant heart failure.

Migratory polyarthritis of large joints occurs when one large joint after another becomes swollen and painful for few days and then subsides spontaneously. Migratory polyarthritis is one of the major manifestations of rheumatic fever.

These are firm but painless nodules that consist of collagen fibers over bones or tendons that can appear on the back of the wrist, outside elbow, and anterior knees. Subcutaneous nodules are one of the major manifestations of rheumatic fever.

Erythema marginatum is a reddish rash that begins as macules on the trunk or arms and spread outward and clear in the middle to form rings. The rings continue to spread and coalesce with other rings but typically spare the face. Erythema marginatum is one of the major criterion of rheumatic fever.

Sydenham's chorea describes a characteristic set of rapid movements of the face and arms that lack purpose. This can occur late in the disease and is a major manifestation of rheumatic fever.

Erythrocyte sedimentation rate is the rate at which red blood cells sediment in a one hour period and is a nonspecific marker of inflammation. ESR is typically elevated in rheumatic fever and is one of the minor criterion.