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Monoarthritis as the initial presentation of acute rheumatic fever in Iran: A single-center retrospective
Vadood Javadi1, Elham Mansourizadeh1, Hassan Pourmoshtagh2
1Department of Pediatric Rheumatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Acute rheumatic fever (ARF) in children can present with monoarthritis, a symptom significantly linked to cardiac involvement. Early identification and cardiac assessment are crucial for managing this global health concern.
Area of Science:
- Pediatrics
- Rheumatology
- Infectious Diseases
Background:
- Limited data exists on acute rheumatic fever (ARF) in Iran, hindering understanding of its prevalence and clinical presentation.
- This study addresses the knowledge gap by investigating ARF cases presenting with monoarthritis in Iranian children.
- Understanding initial ARF symptoms is vital for timely diagnosis and intervention.
Purpose of the Study:
- To determine the prevalence of monoarthritis as the initial symptom of ARF in children aged 3-17 years.
- To analyze the association between ARF monoarthritis and factors such as age, gender, family history, and cardiac involvement.
- To highlight the clinical characteristics of ARF with monoarthritis in the Iranian pediatric population.
Main Methods:
- Retrospective analysis of medical records for children diagnosed with ARF.
- Statistical analysis using the chi-square test (p<0.05) and 95% confidence intervals.
- Evaluation of cardiac involvement based on the revised Jones criteria.
Main Results:
- Sixty-two pediatric ARF patients were included; 66.1% were boys with a mean age of 8.48 years.
- Monoarthritis presented as the initial symptom in 11.29% of cases (7 patients).
- A significant association (p<0.001) was found between monoarthritis and carditis, with 71.4% of monoarthritis cases also exhibiting carditis.
Conclusions:
- Monoarthritis can be an early indicator of ARF in children and is significantly associated with cardiac involvement.
- Comprehensive cardiac evaluation is essential for pediatric ARF patients presenting with monoarthritis.
- Further large-scale research is needed to fully elucidate ARF characteristics in Iran.
Background:
In Iran, there is a lack of information and studies on acute rheumatic fever (ARF), a global health issue. The limited understanding of ARF's prevalence and primary clinical symptoms has led to confusion. This research investigates the characteristics of children aged 3-17 years who experience ARF with monoarthritis as their initial symptom.
Methods:
A retrospective evaluation of medical records of children diagnosed with ARF was conducted. The study aimed to determine the prevalence of monoarthritis as the first manifestation of ARF and its association with age, gender, family history, and cardiac involvement. Categorical variables were analyzed using the chi-square test with a significance level of < 0.05 and a confidence interval of 95%, using SPSS software (Version 23).
Results:
The study included 62 patients with ARF, comprising 41 (66.1%) boys with an average age of 8.48±3.27 years. Among these patients, 12 exhibited cardiac involvement according to the revised Jones criteria, with 5 clinical carditis and 7 cases of subclinical carditis. Monoarthritis was the initial symptom in seven patients (11.29%); five (71.4%) also had carditis. There was a significant association (p<0.001) between monoarthritis and carditis.
Conclusion:
The study concludes that monoarthritis may be an early sign of ARF in children and correlates significantly with cardiac involvement. However, more extensive research with more significant participant numbers is necessary to understand ARF in Iran comprehensively. A thorough cardiac examination is also crucial for patients with ARF and monoarthritis.
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