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AB0911 Acute rheumatic fever case series presenting with arthritis in adults
  1. I Dogan1,
  2. ON Koyun2
  1. 1Rheumatology
  2. 2Internal medicine, Hitit University Corum, CORUM, Turkey

Abstract

Background Acute rheumatic fever (ARF) is an inflammatory reaction to group A hemolytic streptococcus that emerging 2–3 weeks after infection; presenting with joint, cardiac, neurological and dermatological symptoms. The incidence is reported to be 0.5–3: 100.000 in developed countries and 20–100: 100.000 in developing countries.1 ARF is a common disease in Turkey. It is most common between the ages of 6 and 20 years. It is rare in adults and arthritis is common with carditis in adults.2

Objectives Due to the ARF is rarer at adulthood, ARF-associated arthritis at adults has been reported as a case report series.

Methods Five patients who were admitted to our rheumatology policlinic in a tertiary medical center located in Corum province, with early arthritis between 2014 and 2016 were diagnosed with ARF associated arthritis.

Results The age of ARF associated arthritis patients ranged from 35 to 56 years (Mean age 45.6 years). Two of these patients were male and three were female. One patient has atrial fibrillation and coronary artery disease in other one as a comorbidity. All of patients had tonsillitis in the last 15 days. Two of the patients had a previous ARF story.

The results of the laboratory and the clinical findings are given in table:

Acute rheumatic fever associated arthritis was diagnosed according to Jones criteria due to migratory arthritis, carditis findings with Echocardiography, and ASO titer elevation. The ANA, anti-CCP, RF, and Brucella agglutination tests were negative. Non-steroidal anti-inflammatory drugs, oral methyl prednisolone 16 mg per day and benzathidine penicillin G 1.2 million units per month were initiated as treatments. Methyl prednisolone dose was taperde gradually. In one patient using warfarin, depo peniciline i.m. was not given because it could be risky for hematoma. In another patient with coronary artery disease, methylprednisolone 4 mg per day was started because coronary bypass was planned. Symptoms of all patients were improved after treatment.

Conclusions Acute rheumatic fever associated arthritis is not a common condition in adult patients,and should be kept in mind with poststreptococcal reactive arthritis in arthritis developed after upper respiratory tract infections in adults.

References

  1. Stollerman G.H. Rheumatogenic group A streptococci and the return of rheumatic fever, Adv. Intern. Med. 35 (1990) 1–25.

  2. Ben-Dov I. Acute rheumatic fever in adults over the age of 45 years: an analysis of 23 patients together with a review of the literature. Semin Arthritis Rheum. 1980 Nov; 10(2):100–10.

References

Disclosure of Interest None declared

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