Major Criteria (A)PECCS
Aschoff/Anitshchow bodies on Path.
Polyarthritis 75% - usually w/ fever, large joints, migratory (each joint lasts only a few days), painful out of proportion to PE. Total duration less than 6 weeks. Non-destructive. Tx salicylates.
Erythema marginatum - 5% pink evanescent rash over trunk; usually less than 3 mos duration.
Chorea - 10-30%. may be preceded by emotional lability, starts about 6 months after infection; self limited 6-13 weeks, but may last for years. (This may be the only manifestation of ARF, and therefore may be sufficient alone to make the dx. Tx: Thorazine or Haldol. See Sydenham Chorea
Carditis - in 50%, may be ASx. Involves all three layers of the heart. Hallmark: pansystolic blowing mitral murmur, less common is diastolic aortic murmur. Indolent carditis may be the only manifestation in patietns who seek med care months afterward. Tx: 2-4 weeks of steroids.
Subq nodules - 10% small painless swellings over bony prominences; subcutaneous; correlates with heart disease; lasts a couple of weeks; also occurs in SLE and RA
Minor Criteria (B)ELCH
Clinical: fever, arthralgia
Lab: ESR, CRP
EKG: prolonged PR
Hx: previous hx of ARF