Division of Allergy, Asthma and Immunology, Department of Pediatrics, Thomas Jefferson University, 1600 Rockland Road, Wilmington, DE 19803, United States.
Division of Allergy, Asthma and Immunology, Department of Pediatrics, Thomas Jefferson University, 1600 Rockland Road, Wilmington, DE 19803, United States.
Autoimmun Rev. 2014 Apr-May;13(4-5):503-7. doi: 10.1016/j.autrev.2014.01.036. Epub 2014 Jan 11.
Acute rheumatic fever is an inflammatory sequela of Group A Streptococcal pharyngitis that affects multiple organ systems. The incidence of acute rheumatic fever has been declining even before the use of antibiotics became widespread, however the disease remains a significant cause of morbidity and mortality in children, particularly in developing countries and has been estimated to affect 19 per 100,000 children worldwide. Acute rheumatic fever is a clinical diagnosis, and therefore subject to the judgment of the clinician. Because of the variable presentation, the Jones criteria were first developed in 1944 to aid clinicians in the diagnosis of acute rheumatic fever. The Jones criteria have been modified throughout the years, most recently in 1992 to aid clinicians in the diagnosis of initial attacks of acute rheumatic fever and to minimize overdiagnosis of the disease. Diagnosis of acute rheumatic fever is based on the presence of documented preceding Group A Streptococcal infection, in addition to the presence of two major manifestations or one major and two minor manifestations of the Jones criteria. Without documentation of antecedent Group A Streptococcal infection, the diagnosis is much less likely except in a few rare scenarios. Carditis, polyarthritis and Sydenham's chorea are the most common major manifestations of acute rheumatic fever. However, despite the predominance of these major manifestations of acute rheumatic fever, there can be significant overlap with other disorders such as Lyme disease, serum sickness, drug reactions, and post-Streptococcal reactive arthritis. This overlap between disease processes has led to continued investigation of the pathophysiology as well as development of new biomarkers and laboratory studies to aid in the diagnosis of acute rheumatic fever and distinction from other disease processes.
急性风湿热是 A 组链球菌性咽炎的炎症后遗症，影响多个器官系统。即使在抗生素广泛应用之前，急性风湿热的发病率就一直在下降，但该病仍是儿童发病和死亡的重要原因，尤其是在发展中国家，据估计全世界每 10 万名儿童中就有 19 人受到影响。急性风湿热是一种临床诊断，因此取决于临床医生的判断。由于临床表现多种多样，因此 1944 年首次制定了琼斯标准来帮助临床医生诊断急性风湿热。多年来，琼斯标准不断修订，最近一次是在 1992 年，目的是帮助临床医生诊断急性风湿热的初次发作，并尽量减少对该病的过度诊断。急性风湿热的诊断基于有记录的先前 A 组链球菌感染，加上存在琼斯标准的两个主要表现或一个主要表现和两个次要表现。除非有先前 A 组链球菌感染的记录，否则诊断的可能性较小，除非在少数罕见情况下。心肌炎、多发性关节炎和风湿性舞蹈病是急性风湿热最常见的主要表现。然而，尽管急性风湿热的这些主要表现占主导地位，但与其他疾病（如莱姆病、血清病、药物反应和链球菌后反应性关节炎）仍有显著重叠。这种疾病过程之间的重叠导致了对病理生理学的持续研究，以及开发新的生物标志物和实验室研究，以帮助诊断急性风湿热并与其他疾病过程区分开来。
