1. R HEUMATIC F EVER

2. Collagen vascular disease with inflammation involving many organs mainly heart, brain, joints and skin. The acute form of the disease follow infection with gp A β hemolytic streptococcus of the tonsillo-pharynx ( only ) with a latent period 2-4 wks.

3. The importance of Rf is its ability to cause fibrosis of the cardiac valves, leading to a devastating hemodynamic heart diseases and regarded as the most common cause of heart disease in childhood and young adults world wide.

4. Incidence : developed Countries decreased,housing,medical care developing countries still high incidence(1/ 1000) age :6-15 yrs Affected population: militaries,school contacts, m=f Climate: worm tropical A β hemolytic streptococcus M strain epitopes shared with human heart,myocin,sarcolemal tissue Attack rate:3% in risky people

6. Pathology: Fibrinoid degeneration fragmentation all organs involved collagen edema infiltration,mononuclear histiocyte heart(IVS) aschoff cells hyaline degeneration fibrosis calcification

7. Diagnosis There is no single specific clinical,lab or test. Duckett jones criteria :  Major criteria: 1.Carditis 2.arthritis 3.Chorea 4.Erythema marginatum 5.Subcutaneous nodule  Minor criteria: 1-clinical finding : arthritis Fever 2-Lab investigation : raised acute phase reactant CRP,ESR prolong PR interval Previous signs of streptococcal infection.Raised ASOT.Throat culture

8. C ARDITIS PAN, PREVALENCE ~ 50%,MR,AR THE HALLMARK OF ARF

9. Arthritis Migratory, large, multi, asymmetrical, Inflammatory, salicylate responsive,benign remain for 2-3wk Prevalence 70%,

10. Sydenham Chorea St.vitus dance, chorea minor Involuntary, purposeless, uncoordinated movement with weakness& emotional liability. basal ganglia, caudate nucleus About 20%,a later manifestation(3 months vs 3 wks) During awake,hand writing, remain for 1-2 wks For the future neuro psychosis, obsession,recurrence

11. Erythema Marginatum Evanescent, erythematous, macular rash,pale center, rounded edge, on the trunk and extremities sparing the face. More rare 5%, More clear by applying heat

12. Subcutaneous nodule Fine, painless,freely mobile,nodule,0.5-2cm,on the extensor surface of joints occipital &spinal process Rare 3%, often associated with carditis

13. Minor criteria Fever and joint pain are non specific, for support diagnosis if had single major criteria. Lab investigation: acute phase reactant raised early, normal in chorea ECG prolong PR interval

14. Previous signs of streptococcal infection: ASOT Throat culture

15. Treatment(RASSA) Rest Salicylate Steroid Antibiotics: Primary prevention Secondary prevention