Rheumatic Fever versus Rheumatoid Arthritis - USMLE Forums
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  #1  
Old 02-29-2012
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Question Rheumatic Fever versus Rheumatoid Arthritis

plz can u tell the difference between these two??bot occur after strep infection...but just cant find all differnces between the two to note down in one place...please help me...just want to get the diffences (all of them) so that when time comes can look at them and get the concept right..please:sorry:
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Old 02-29-2012
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No sir I havent come across anywhere that Strep infection causes Rheumatoid Arthritis :0

RF is of heart occuring after 2 weeks of URTI. Involving Mitral & Tricuspid valves

RA is joint inflammation improving over the day. RF is positive in 70% people
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Old 02-29-2012
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Default Even I used to get confused between these 2!

Well,

Rheumatic fever is an immunologic disorder. Specifically type II hypersensitivity. Antibodies against Strep. pyogenes cross react with multiple tissues like heart, joints etc.

While RA is an chronic autoimmune disorder characterized classically by symmetric small joint arthritis & other systemic symptoms +/- serological markers (Rheumatoid Factor & Anti-citrulinnated protein antibody)
Classic hand deformity -
http://en.wikipedia.org/wiki/File:Rh..._Arthritis.JPG

The diagnosis of rheumatic fever can be made when two of the major criteria, or one major criterion plus two minor criteria, are present along with evidence of streptococcal infection: elevated or rising antistreptolysin O titre or DNAase.

Major criteria
Migratory polyarthritis involving large joints
Carditis - pancarditis
Painless subcutaneous nodules, often on extensor surfaces
Erythema marginatum
Sydenham's chorea (alone is sufficient to make Dx)

Minor criteria
Fever
Arthralgia
Raised ESR or CRP
Leukocytosis
1st degree heart block
Previous episode of rheumatic fever or inactive heart disease


Diagnostic algorithm for RA
Target population (who should be tested?): patients who
 1) have at least one joint with definite clinical synovitis (swelling)*
 2) with the synovitis not better explained by another disease†
Classification criteria for RA (score-based algorithm: add score of categories A–D a score of ≥6/10 is needed for classification of a patient as having definite RA)
 A. Joint involvement§
  1 large joint 0
  2−10 large joints 1
  1−3 small joints (with or without involvement of large joints) 2
  4−10 small joints (with or without involvement of large joints) 3
  >10 joints (at least one small joint) 5
 B. Serology (at least 1 test result is needed for classification)
  Negative RF and negative ACPA 0
  Low-positive RF or low-positive ACPA 2
  High-positive RF or high-positive ACPA 3
 C. Acute-phase reactants (at least one test result is needed for classification)
  Normal CRP and normal ESR 0
  Abnormal CRP or normal ESR 1
 D. Duration of symptoms
  <6 weeks 0
  ≥6 weeks 1
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Old 02-29-2012
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Quote:
Originally Posted by xpabhishek View Post
Well,.......≥6 weeks 1
Thanks a lot..just noting it down..many thanks again
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Old 02-29-2012
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Quote:
Originally Posted by bunny View Post
No sir I havent come across anywhere that Strep infection causes Rheumatoid Arthritis :0

RF is of heart occuring after 2 weeks of URTI. Involving Mitral & Tricuspid valves

RA is joint inflammation improving over the day. RF is positive in 70% people
yes absolutely..u were so right..i in fact was confused with it...thanks a lot
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Old 02-29-2012
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just remembered one more
Also note down

RF is type 2 hypersensitivity
RA is type 3 hypersensitivity
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Old 03-01-2012
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add few more points........

RF:commonly involves large joints,small joints involvement is uncommon,asymmetrical joints involvement
RA:involve both large and small joints,symmetrical joint involvement

RF:acute onset,lasts for shorter period
RA:insidious onset,lasts longer than RF

RF:arthritis dramatically responds to aspirin
RA:arthritis mainly responds to DMARDs

RF:usually no deformity of joint occur
RA:high rate of deformity of joint

RF:H/o sore throat 2-4 weeks prior to onset of illness
RA:usually there is no h/o sore throat

RF:it involves heart(carditis/valvular lesion) and brain(chorea) other than joint
RA:uveitis,lymphadenopathy,hepatosplenomegaly occur other than arthritis
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Old 03-01-2012
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Also RF and heart, first myocarditis of the heart, years later the mitral and aortic valve dz occurs. The dmg to the heart is permanent and those whom is susceptible for recurrent RF often goes on prophylactic penicillin to prevent further cross-reacting antibodies.
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Old 03-01-2012
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Now i think its a great thread considering the compare and contrast of these two very imp disease and often they get jumbled up..any more differences..just keep them coming..will be happy to jot them down in my notes
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