Changes in valvular regurgitation in mid-term follow-up of children with first attack acute rheumatic fever: first evaluation after the updated Jones criteria

Abstract

Aim:In present study, we aimed to evaluate the changes in valvular regurgitations in mid-term follow-up of children with first attack acute rheumatic fever diagnosed after updated Jones criteria.Materials and methods:The medical records of the children diagnosed with acute rheumatic fever between June 2015 and November 2018 were evaluated retrospectively. When compared to the findings during diagnosis, the changes in the degree of valvular regurgitation in the last visit were coded as same, regressed, or disappeared.Results:A total of 50 children were diagnosed with the first attack of acute rheumatic fever between the noted dates. Nine patients (18%) could be diagnosed depending on the new criteria. Eight patients did not have carditis, and 35 patients (49 valves) could be followed for a median follow-up period of 11.7 ± 3.3 months. In our study, the valvar lesions continued in 82% of patients with clinical carditis at the end of the first year and the degree of valvular regurgitation decreased in 39% of them. Despite this, in a significantly higher (p = 0.031) ratio of patients with silent carditis (41%), valvar lesions disappeared in the same follow-up period. In 18.4% of the involved valves, regurgitation regressed to physiological level.Conclusion:Updated Jones criteria make it possible to diagnose a significant number of patients, and the ratio of complete recovery among patients with silent carditis is significantly higher. Also, it can be speculated that the normal children in whom a physiological mitral regurgitation is detected should be followed in terms of rheumatic heart disease.

Frequency of Familial Mediterranean Fever Gene Mutation in Patients Presenting With Joint Pain and Diagnosed With Acute Rheumatic Fever

“…There was also no significant difference among these groups by carditis. The increase in ASO titer, which indicates that the streptococcal infection has passed, is also a supportive finding [1,2]. Accordingly, one major and two minor or two major criteria must be present in the first attack, which is one of the Jones criteria.…”

“…ARF is diagnosed based on the Jones Criteria, revised by the American Heart Association in 2015. These criteria recommend different diagnostic approaches for low and medium/high-risk populations [1], with Turkey falling into the medium/high-risk group [2]. Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disorder characterized by serosal inflammation (peritonitis, pleuritis, and arthritis) and recurrent fever attacks.…”

“…For ARF, the major criteria in medium to high-risk classification are carditis, joint involvement (monoarthritis, polyarthritis, and/or polyarthralgia), Sydenham's chorea, erythema marginatum, and subcutaneous nodules. Minor criteria are ≥38 °C, PR prolongation, erythrocyte sedimentation rates (ESR) ≥ 30 mm, monoarthralgia, and/or C-reactive protein (CRP) ≥ 3.0 mg/dl[1,2]. All patients were physically examined and evaluated using electrocardiogram and echocardiography in the pediatric cardiology clinic.…”

Early diagnosis of acute rheumatic fever and rheumatic heart disease as part of a secondary prevention strategy: Narrative review

“…Evaluations of the revised Jones criteria have reported that the changes improve the diagnosis of ARF among moderate and high‐risk populations 23 and allow to properly assess the risks associated with the occurrence of latent RHD 24 . A Turkish study involving 50 children reported that the updated Jones criteria prevented under diagnosis of ARF in 18% of the children 25,26 . In addition, other studies have reported that the changes will lead to better clinical outcomes for the disease, through earlier disease identification 27,28 …”

“…24 A Turkish study involving 50 children reported that the updated Jones criteria prevented under diagnosis of ARF in 18% of the children. 25,26 In addition, other studies have reported that the changes will lead to better clinical outcomes for the disease, through earlier disease identification. 27,28…”