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Acute rheumatic fever: Clinical manifestations and diagnosis

Andrew Steer, MBBS, PhD, FRACP
Allan Gibofsky, MD, JD, FACP, FCLM
Section Editors
Robert Sundel, MD
Daniel J Sexton, MD
Deputy Editor
Elizabeth TePas, MD, MS


Acute rheumatic fever (ARF) is a nonsuppurative sequela that occurs two to four weeks following group A Streptococcus (GAS) pharyngitis and may consist of arthritis, carditis, chorea, erythema marginatum, and subcutaneous nodules. Damage to cardiac valves may be chronic and progressive, resulting in cardiac decompensation.

The clinical manifestations and diagnosis of ARF are reviewed here. The epidemiology, pathogenesis, treatment, and prevention of this disorder are presented separately. (See "Acute rheumatic fever: Epidemiology and pathogenesis" and "Acute rheumatic fever: Treatment and prevention".)


Acute illness — ARF can present with several different clinical findings within weeks of a group A streptococcal (GAS) tonsillopharyngitis (or streptococcal pyoderma in patients from tropical regions) [1-3]. The possible major and minor manifestations are reviewed here. These manifestations are used for diagnosis (Revised Jones Criteria) [4,5]. The diagnostic criteria are reviewed below. (See 'Diagnosis' below.)

The five major manifestations (and percent of patients with each) are [4]:

Carditis and valvulitis (eg, pancarditis) that is clinical or subclinical – 50 to 70 percent

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Literature review current through: Nov 2017. | This topic last updated: Jan 06, 2017.
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