[Rheumatic fever: atypical joint manifestations]

Area of Science:

• Pediatrics
• Rheumatology
• Infectious Diseases

Context:

• Rheumatic fever (RF) diagnosis presents challenges in pediatrics.
• The polymorphism of clinical presentation and lack of specific lab tests complicate RF diagnosis.
• Arthritis is the most frequent yet least specific of the Jones' major criteria.

Purpose:

• To analyze the clinical presentation of arthritis in pediatric rheumatic fever.
• To evaluate the diagnostic utility of arthritis as a sole major criterion in RF.
• To highlight the importance of carditis or chorea in confirming RF with atypical articular involvement.

Summary:

• A study of 93 children with 117 RF flares found arthritis was the only major criterion in 45% of cases.
• Migratory arthritis occurred in 64% of flares, with polyarthritis being most common (64%).
• Definitive RF diagnosis with isolated atypical arthritis required co-occurring carditis or chorea.

Impact:

• Physicians must recognize atypical presentations of RF, especially when arthritis is the sole major criterion.
• This study emphasizes the need for careful evaluation beyond just arthritis for accurate RF diagnosis in children.
• Increased awareness of atypical RF manifestations can improve diagnostic accuracy and patient outcomes.