Which clinical history findings are characteristic of 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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Usually, a latent period of approximately 18 days occurs between the onset of streptococcal pharyngitis and the onset of acute rheumatic fever (ARF). This latent period is rarely shorter than 1 week or longer than 5 weeks.

Approximately 70% of older children and young adults recollect the pharyngitis. However, only approximately 20% of young children recollect pharyngitis. Therefore, younger children who present with signs or symptoms consistent with ARF merit a higher index of suspicion. [21]

Typically, the first manifestation of ARF is a very painful migratory polyarthritis. Large joints such as knees, ankles, elbows, or shoulders are typically affected. Often, associated fever and constitutional toxicity develop. Sydenham chorea (ie, rapid, irregular, aimless involuntary movements of the arms and legs, trunk, and facial muscles [22] ) was once a common late-onset clinical manifestation but is now rare. [4] Acute attacks usually resolve within 12 weeks.

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