What is ARF?
What is Acute Rheumatic Fever (ARF)?
Acute Rheumatic Fever (ARF) is an illness that is caused by a germ called Streptococcus also known as strep. The strep germ is a common cause of sore throat and skin sores in school aged children 5-15 years old.
ARF happens when the body (immune system) mistakenly attacks healthy parts of itself especially the big joints and the heart causing inflammation. This is called acute rheumatic fever.
Individuals with ARF are often unwell and have significant joint pains and require hospitalization. Sometimes ARF affects the brain which makes parts of the body to twitch and jerk. This is called ‘Chorea’.
The major risk from ARF is the possible long-term damage of the heart valve.
Who gets ARF?
- Globally, ARF and RHD are more common in indigenous communities than non-indigenous communities.
- ARF commonly affects school-aged children between the ages of 5-15 years old; but can occur amongst young people as well.
Symptoms
Symptoms of acute rheumatic fever normally begins 2 to 3 weeks after a strep infection.
Some of the most common symptoms are:
- Lumps (Subcutaneous nodule- a small number of people will have lumps underneath the skin)
- Shortness of breath
In some cases, rheumatic fever can cause damage to the heart valves. Though most symptoms of rheumatic fever will get better fairly quickly, any damage to the heart will be long-term and may worsen with further attacks of rheumatic fever.
Diagnosis – How is ARF diagnosed
Guidelines are used to determine whether someone has ARF. Doctors will ask for a list of symptoms, your medical history and if you or your child has had a recent episode of strep throat. Next a physical examination will be conducted where the doctor will look at the following:
- look for rash/lump (skin nodules)
- examine joints for inflammation.
- listen to your heart to check for abnormalities.
- blood test.
- Heart scan (echocardiography, echo)
- Heart tracing (ECG)
For more technical information about diagnosis of ARF, please click the link below:
How ARF affects the body
Your body produces antibodies (soldiers of the body) that attack the strep germ.
When there is a strep infection, the soldiers of the body are confused and mistakenly attack healthy tissues like the heart valves, joints, the skin and brain.
Prevention
The main ways to prevent ARF is:
- Benzathine Penicillin (BENZA) for those who have had rheumatic fever in the past
- Treat Group A strep infection with antibiotics, ensuring completion of all prescribed doses of medication
- improved health seeking behavior (visit nearest Health Center when you are sick – do not wait 3 days later)
- improved sanitation (practice washing hands regularly every time before putting hands in mouth), hygiene and nutrition (eat a lot of immune boosting foods like veggies and fruits, keep a balanced diet)
Treatment
The most effective treatment involves getting rid of the Group A strep and treating and controlling the symptoms.
Once diagnosed with Rheumatic Fever, treatment may include:
- antibiotics (Benzathine Penicillin)
- Pain killer
- anticonvulsant medicine (cases with severe involuntary movement, jerky)
- bed rest or restricted activities
If you have had rheumatic fever once than there is a high chance it could come back. A long-term treatment of Benzathine penicillin will be prescribed which is the only good way to stop ARF happening again and protect you from getting sick.
Benzathine Penicillin or Benza injections are given every 3 to 4 weeks (depending on the severity of the illness) once diagnosis of ARF is confirmed. you might have to take Benza for several years to help stop ARF returning and prevent causing permanent damage to your heart valves. Each time ARF comes back the heart valves can get damaged, so the heart gets weaker and weaker, and doesn’t work properly.
The valves in the heart help move blood in the right direction. Rheumatic heart disease occurs when they are affected.