What is acute rheumatic fever (ARF)?

Updated: Dec 10, 2020
  • Author: Robert J Meador, Jr, MD; Chief Editor: Herbert S Diamond, MD  more...
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Acute rheumatic fever (ARF) is a sequela of streptococcal infection—typically following 2 to 3 weeks after group A streptococcal pharyngitis—that occurs most commonly in children and has rheumatologic, cardiac, and neurologic manifestations. [1, 2] The incidence of ARF has declined in most developed countries, and many physicians have little or no practical experience with the diagnosis and management of this condition. Occasional outbreaks in the United States make complacency a threat to public health.

Diagnosis rests on a combination of clinical manifestations that can develop in relation to group A streptococcal pharyngitis. [3] These include chorea, carditis, subcutaneous nodules, erythema marginatum, and migratory polyarthritis. (See the image below.) Because the inciting infection is completely treatable (see Treatment), attention has been refocused on prevention.

Clinical manifestations and time course of acute r Clinical manifestations and time course of acute rheumatic fever.

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