Synopsis
Recognise post-streptococcal inflammatory disease, prevent recurrence and manage chronic valve damage in a UK pathway.
- Acute rheumatic fever (ARF) is an immune-mediated complication usually appearing 1-5 weeks after group A streptococcal throat or skin infection.
- Use revised Jones criteria plus evidence of preceding streptococcal infection; polyarthritis, carditis, chorea, erythema marginatum and subcutaneous nodules are the classic major manifestations.
- Echocardiography with Doppler is required in suspected or confirmed ARF even when auscultation is normal because carditis may be subclinical.
Key red flags
Tachycardia, new MR/AR murmur, cardiomegaly, pericarditic features or heart failure indicates pancardial involvement; Doppler-only valvulitis also counts.
Investigation priorities
Demonstrate preceding group A streptococcal infection.
Management branches
Compatible major/minor manifestations after possible GAS infection.
- Admit if carditis, heart failure, important arrhythmia, neurological risk or diagnostic instability; obtain ECG, inflammatory markers, GAS evidence and TTE.
- Apply revised Jones criteria and actively exclude septic arthritis, endocarditis, viral myocarditis, autoimmune disease and drug/toxin causes of chorea.
Key medicines
Benzathine benzylpenicillin1.2 million units by deep IM injection every 3-4 weeks for secondary prophylaxis; the SmPC also licenses 1.2 million units IM as a single general streptococcal treatment dose.
Phenoxymethylpenicillin250 mg by mouth twice daily for prevention of recurrent rheumatic fever.