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Rheumatic Fever Synopsis:


Thanks, all who responded to my question about what the diagnostic criteria
would have been in the 60s, when I was diagnosed with rheumatic fever.


One lister said her brother had been diagnosed with rheumatic fever in the
60s (as I had). She was kind enough to ask her mother about her brother’s
problems. Her mother thought he might have had a high white count as a flag,
but said a more specific test showed he was negative (ASO?) . His symptoms
were knee joint immobility and fever. He was placed on low-dose penicillin
until he was 12 (like I was).



Another person  wrote to say doctors are often wrong and to try to be happy
and get more sleep than I think I need. Good advice!



Another wrote to say her brother was diagnosed with RF but when he got his
“tonsil tags” removed, there was no more rheumatic fever.



Yet another wrote to say she had rheumatic fever in the 50s, diagnosed by a
tumor on the leg that was removed and biopsied. I had never heard of that
before, but have found out that’s one of the possible criteria for
diagnosis, occurring in 20% of patients. Nodules can occur along synovium.
From the Merck Manual: Subcutaneous nodules appear indistinguishable from
those of Rheumatoid Arthritis, but biopsy shows features resembling Aschoff
bodies



Another person wrote to say there isn’t much diagnostic overlap between CD
and suggested I Google “Jones Criteria” for the 40s and 50s. I could only
find updated info, but,



Another lister went to the trouble to photocopy a medical text published in
1966, just a year before I was diagnosed.  That info said that high sed rate
was common in cases of heart failure and a leukocyte count of 15,000-30,000
was the rule, but could be normal. C-Reactive protein content is good at
indicating rheumatic activity but will appear during the course of any
bacterial infection. Of significance is the finding of a high
antistreptolysin titers of 200 or more indicate a recent infection by group
A streptococci, but aren’t diagnostic of rheumatic fever. But early in the
course of RF, titers of less than 100 are rare.



The text (1966, 5th edition of "Principles of Internal Medicine" by Adams,
Bennet, Reznik, Thorn, and Wintrobe)  goes on to say that 2 or more
manifestation of the Jones Criteria must occur in order to get a RF
diagnosis.  Jones Criteria: 1.) carditis, 2.)polyarthritis, 3.) chorea,
4.)erythema marginatum, and 5.)subcutaneous nodules



From Medilexicon: http://www.medilexicon.com/medicaldictionary.php?t=21464

 Updated Jones Criteria allows for one of the above Major Criteria
concurrent with 2 of Minor Critera that include  fever, arthralgia, elevated
erythrocyte sedimentation rate or C-reactive protein, and prolonged PR
interval on ECG. From the manual: Diagnosis requires evidence of recent
group A β-hemolytic streptococcal infection, plus two major and one minor
criteria, or one major and two minor criteria; revised Jones criteria allow
the diagnosis when indolent carditis or chorea exists with no other cause,
or in patients with a previous history of rheumatic fever who have one major
or two minor criteria in association with a recent streptococcal infection.



One woman wrote to say she had a false rheumatic fever diagnosis because of
a high sed rate and tachycardia. She said these were found to be both  caused
by celiac disease. Neurological damage caused by an over-reactive vagus
nerve caused the tachycardia  (high heart rate).



Another woman wrote to say her mother in law was diagnosed with both
rheumatic fever and celiac disease but wasn’t strict with her diet.


One man wrote to say he felt it was possible not to have long-term heart
damage after having rheumatic fever. My research found this to be true,
contrary to what doctor #2 told me.


*Another guy said an antibody for strep (ASO or antistreptolyn O titer) was
available in the 60s but it isn’t inconceivable that there could have been a
false positive because of celiac disease and that it would have shown up
after a recent strep infection anyway (strep is the removable trigger for
RF)*

*
*

I’m not sure whether I had it or not, since I'm not sure what the doc saw or
which tests he ran. I remember reporting "growing pains."  I also have
autoimmune thyroid disease and celiac disease, which have some symptoms in
common with RF, such as arthralgia and tachycardia.

I do think, however, that it was possible. I will certainly continue to take
seriously any possible strep throat symptoms.


Thanks again everybody!

Kit in St. Louis

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