Significant cause of cardiovascular morbidity in developing countries and still present in the USA, although declining in incidence.
American Heart Association update of the Jones Criteria (1992):
Major Criteria (1) Carditis (of any of the layers of the heart) (2) Polyarthritis (3) Subcutaneous Nodules (4) Erythema Marginatum (5) Chorea
Minor Criteria (1) Arthralgia (not a criterion if polyarthritis is present) (2) Fever (3) Elevated acute-phase reactants (ESR, CRP) (4) Prolonged P-R interval
Diagnosis made by presence of TWO MAJOR or ONE MAJOR PLUS TWO MINOR.
Diagnosis can also be made with presence of chorea and documented strep pharyngitis.
Acute Management
Treat the Infection (1) Penicillin (Pen V for 10 days or Pen G IM)
Alleviate Symptoms (1) Salicylates are particularly effective for migratory arthritis (2) High Dose ASA (80-100mg/kg/Day for several weeks, and then taper) (3) NSAIDs for those who cannot tolerate ASA (4) Steroids reserved for moderate to severe carditis.
