Clinical review Rheumatic fever and its management

The diagnosis of acute rheumatic fever is a clinical challenge and depends on the possibility of the disease being borne in mind. Although the complete eradication of rheumatic fever from the Western world has not been achieved, the disease is often forgotten in the differential diagnosis of a patient with fever and polyarthralgia or arthritis. Rheumatic fever remains an important acquired cardiac disease in low and middle income countries and among poorly resourced communities in high income countries. Rheumatic heart disease places a heavy economic burden on the healthcare system in low and middle income countries because of the costs of medical treatment and heart valve surgery and also because it is a disease of young adults, who are the most economically active group of any population. Management is complex and involves different levels of care. The only new advances in the management of acute rheumatic fever to date are in the development of vaccines.