A nonsuppurative, acute inflammatory condition resulting from group A streptococcal infection. Arthritis, chorea, and carditis occur alone or in combination. Subcutaneous nodules and erythema marginatum of the skin may be involved.

Rheumatic fever is etiologically associated with the group A streptococcus. Constitutional and environmental factors that may contribute to the condition are unknown. Malnutrition, overcrowding, and lower socioeconomic status appear to make a person more susceptible to streptococcal infections and subsequent rheumatic attacks.

The five major manifestations of rheumatic fever are migratory polyarthritis, chorea, carditis, subcutaneous nodules, and erythema marginatum. Skin-related manifestations are uncommon, and almost never occur alone. These manifestations usually appear in a patient who already has arthritis, chorea, or carditis. Fever may also occur.

The erythrocyte sedimentation rate (ESR) and C-reactive protein tests are done. The white blood cell (WBC) count reaches 12,000 to 20,000/?L and the serum C-reactive protein is abnormally high.

Patients are advised to limit their activities if symptoms of arthritis, chorea, or heart failure occur. If carditis is not manifested, there are no physical restrictions after the acute episode subsides. Strict bedrest is not necessary for patients who do not experience symptoms, but do have carditis. Restrictions on activity are only helpful for patients with symptomatic heart failure.

For patients who have only arthritis, the aim is to relieve pain. Codeine or other analgesics, such as a nonsteroidal anti-inflammatory drug (NSAID) in small doses, are usually adequate in mild cases. In more severe cases, use of anti-inflammatory drugs may be required.

Blood or urine levels of salicylate are needed to monitor for toxicity. If salicylate toxicity occurs, patients may experience tinnitus, headache, or tachypnea. These manifestations may not appear until 1 week or more after patients receive salicylates.

The goal of treatment in carditis is to decrease inflammation and prevent rebounding of the condition. Aspirin or another NSAID are the drugs of choice in less than severe cases. However, in severe carditis, especially with heart failure, aspirin may not be effective and corticosteroids are used. In addition, antibiotics may be used to remove any lingering organisms.

In cases where severe carditis occurs in the acute episode, residual heart disease may transpire. Murmurs will ultimately disappear in about 50% of patients whose acute episodes included mild carditis without major cardiac complications. Risk of recurrences depends on the severity of carditis during the acute phase of illness. Recurrences may cause or worsen permanent cardiac damage. Other manifestations of rheumatic fever subside without residual effects.

1. May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% and/or other requirements/qualifications under 38 CFR §3.350 [Special monthly compensation ratings]. Also reference 38 CFR 3.155(d)(2).

2. Rheumatoid arthritis and rheumatic fever are unrelated. During acute rheumatic fever there may be migratory joint pain and an "infectious arthritis" usually involving acute joint swelling and inflammation that resolves without permanent joint changes or damage; while rheumatoid arthritis, though it has acute phases as well as its chronic residual joint degeneration, does not involve rheumatic fever at any time in either its acute or chronic phases. Additionally in rheumatoid arthritis rheumatoid factor (RF) is usually elevated but negative in rheumatic fever.

• Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, heart damage.

• Rheumatic Fever. Rheumatic fever is an acute, subacute, or chronic systemic disease. For unknown reasons it may either be self-limiting, or lead to slowly progressive valvular deformity. Complications of rheumatic fever include cardiac arrhythmias, pericarditis, rheumatic pneumonitis, pulmonary embolism, and infarction, valve deformity and, in extreme cases, congestive heart failure (CHF). The prognosis for life is good. If the age of onset is postadolescence, residual heart damage occurs in less than 20 percent of the cases, and is generally less severe than if the onset is during childhood. Mitral valve insufficiency is the most common residual (M21-1MR, Part III, Subpart iv, Chapter 4, Section C, Topic 15).