Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be

talking to you about rheumatic fever. And you can find written notes on this topic at zero definals.com

slash rheumatic fever or in the rheumatology section of the zero definals pediatrics book.

So let's get straight into it.

Acute rheumatic fever is an autoimmune condition triggered by streptococcus bacteria.

It's caused by antibodies created against the streptococcus bacteria that also target tissues in the body. Rheumatic fever is a multi-system disorder that affects the joints, heart, skin and nervous system. Rheumatic fever is rare in the UK

due to early treatment of streptococcus infections with antibiotics.

Let's talk about the path of physiology.

Rheumatic fever is caused by Group A beta-hemolytic-lytic-cocki bacteria,

typically streptococcus pyogenes, which causes tonsillitis.

The immune system creates antibodies against these bacteria to fight the infection. These antibodies not only target the bacteria but they also match antigens on the cells of

the person's body, for example the muscle cells in the myocardium of the heart. This results in a type 2 hypersensitivity reaction

where the immune system begins attacking cells throughout the body. This process is usually delayed

two to four weeks after the initial infection. So how does it present? The typical presentation

of rheumatic fever occurs two to four weeks

following a streptococcal infection such as tonsillitis. Symptoms affect multiple systems

including fever, joint pain, rash, shortness of breath, correa and nodules.

Let's talk in more detail about the joint involvement.

Rheumatic fever causes a migratory arthritis affecting the large joints.

It causes hot, swollen and painful joints.

It's described as migratory because different joints become inflamed and improve at different

times, giving the appearance that the arthritis is moving from one joint to the next.

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