Current Clinical Profile of Acute Rheumatic Fever and Recurrent Acute Rheumatic Fever in Pakistan.

Area of Science:

• Rheumatology
• Cardiology
• Pediatrics

Background:

• The 2015 Revised Jones Criteria incorporate echocardiography and specific arthralgia/arthritis presentations for high-risk groups.
• This update may influence the observed clinical variability of acute rheumatic fever (ARF) across diverse populations.

Purpose of the Study:

• To compare the clinical profiles of patients experiencing first-time versus recurrent episodes of ARF.
• To evaluate patient presentations using the most recent diagnostic criteria for ARF.

Main Methods:

• A cohort of 130 consecutive ARF patients were studied between August 2019 and March 2022.
• Cardiac evaluation utilized World Heart Federation standardized echocardiographic criteria.
• Socio-demographic data, clinical features, and investigations were systematically recorded.

Main Results:

• The study included 20.8% first ARF episodes and 79.2% recurrent ARF episodes.
• Carditis was the most frequent presentation (93.8%), followed by polyarthralgia (35.4%) and polyarthritis (24.6%).
• Monoarthralgia was significantly more common in first ARF episodes (29.4% vs. 3.2%), whereas carditis (97.1% vs. 81.5%) and congestive cardiac failure (18.5% vs. 5.9%) were more prevalent in recurrent ARF.

Conclusions:

• The diagnostic categorization within the Jones criteria highlights significant variability in ARF clinical presentations among different populations.
• Monoarthralgia is a key indicator for initial ARF episodes.
• Carditis is the predominant feature in recurrent ARF, underscoring the importance of cardiac monitoring.