Modern features of articular syndrome in acute rheumatic fever in children

Rheumatoid arthritis has features of both post-infectious and autoimmune arthritis and is one of the first manifestations of acute rheumatic fever (ARF). A typical articular syndrome with ARF develops 2–3 weeks after nasopharyngeal streptococcal (β-hemolytic streptococcus of A – BGSA group) infection, is a migrating polyarthritis, with large joints lesion and an intense pain syndrome, that stops with non-steroidal anti-inflammatory drugs (NSAIDs). Atypical course is characterized by arthritis duration >3 weeks, monoarthritis, hands and feet small joints lesion, spine and/ or hip joints; NSAIDs ineffectiveness. Objective of the research – to determine rheumatoid arthritis modern features, incl. course structure and nature in children. Study materials and methods: the study included 56 children 4–17 years old with ARF, hospitalized in Morozov Children's City Clinical Hospital in 2001–2015. Clinical anamnestic, laboratory (ASLO, CRP, protein fractions, cardiomarkers) and instrumental (ECG, ECHOKG) methods were used. Results statistical processing was performed with STATISTICA 8.0 software package (StatSoft Inc., USA). Differences were considered statistically significant at significance level p<0,05. Results: articular syndrome was diagnosed in 33 children (58,9%), was presented by arthritis in 26 children (46,4%), arthralgia – in 7 children (12,5%) and was combined with other ARF manifestations, often with carditis. A typical joint syndrome was diagnosed in 7 children (26,9%), atypical – in 19 (73,1%). Mainly it affected ankle (76,9%) and knee (42,3%) joints. In atypical course, polyarthritis (63,2%) with hands and feet small joints and spine involvement developed more often compared with the typical (28,6%) (χ2 (df=2) =5,99, p=0,05). Clinical instrumental signs of disease activity were often observed in atypical arthritis course (χ2 (df=2) =6,94, p=0,03). Conclusion: despite a significant decrease in ARF incidence, a high percentage of late disease diagnosis remains. ARF diagnosis can not be ignored with atypical arthritis debut. Any patient with an articular syndrome and signs of BHSA infection one should consider as a patient with a probable ARF, perform a thorough control of cardiovascular system condition, follow the principles of ARF secondary prevention. © 2017, Pediatria Ltd. All rights reserved.