Rheumatic fever in adult patients

A study of rheumatic fever in adult patients (diagnosed according to the Jones revised criteria; Circulation 36: 664, 1965) was performed by examining 26 patients during the acute phase of the disease, and by re-examining 22 of them from 6 months to 64 months later (mean 33 months). Polyarthritis and carditis were the most common major manifestations. 23 patients had polyarthritis and 3 monoarthritis. 18 patients had signs of acute cardiac involvement. Carditis appeared to be rather benign: at the acute stage no patient developed congestive heart failure or any other serious complication. Five patients had erythema marginatum, but we saw no chorea or subcutaneous nodules. Of the 22 patients examined in the follow-up study, 4 had persistent signs of cardiac involvement and 15 showed chronic joint manifestations. Yersinia enterocolitica infection was by far the most difficult differential diagnostic problem, since polyarthritis and carditis associated with this enteric infection were very similar to those in patients with rheumatic fever. Current literature on rheumatic fever and the results of this series suggest that the diagnostic criteria of rheumatic fever (Jones) should be re-evaluated, at least in industrial countries.