Pediatric Rheumatology Online Journal → August 2003 → Rheumatic Fever → Abstract #156

ACUTE RHEUMATIC FEVER (ARF) IN MARITIME CANADA- A 32 YEAR HISTORY IN A TERTIARY CARE PEDIATRIC HOSPITAL

S. E. Ramsey,¹ A. M. Huber,¹ A. E. Warren,¹ B. A. Lang.¹

¹Pediatrics, Dalhousie University/ IWK Health Centre, Halifax, NS, Canada

Purpose: The incidence of Acute Rheumatic Fever (ARF) has been increasing over the past 20 years in North America. The purpose of this review is to describe the spectrum of ARF in the pediatric tertiary care hospital in Maritime Canada.
Patients and Methods: All patients with a diagnosis of ARF assessed by a pediatric cardiologist from our institution between 1970 and 2002 were identified using the cardiology database. The health records of 25 out of 26 patients were available and reviewed to confirm the diagnosis of ARF based on the Jones Criteria most current at the time of referral.
Results: Three patients had the diagnosis rejected upon referral. One had the diagnosis of ARF changed to post-streptococcal reactive arthritis based on a lack of evidence of carditis on re-evaluation over 8 months. Eight records had insufficient information to confirm ARF. Thirteen patients (7 girls, mean age 8.4 years) met the Jones Criteria for ARF in 1970-79 (n=7), 1980-89 (n=1), 1990-99 (n=1) and 2000-02 (n=4). The majority presented with carditis and migratory polyarthritis (n=7), 2 of whom were intially mistaken for septic arthritis of the toe. Carditis alone (n=3), carditis and chorea (n=2), and carditis and subcutaneous nodules (n=1) were less common. No patient had erythema marginatum. Carditis involved the mitral valve (n=6), mitral and aortic valves (n=4), aortic valve (n=2), and was panvalvular in 1. The patient who developed panvalvular involvement had coronary artery ectasia during his acute illness. Preceding pharyngitis was documented in 6 patients, and a positive family history of ARF in 4.
Conclusions: ARF is rare in Maritime Canada although there appears to be an increase in cases since 1999. The diagnosis can be difficult even with evaluation by experienced subspeciality physicians. Re-examination over time is critical.