Page 146 - Clinical Pearls in Cardiology

134 Clinical Pearls in Cardiology

elevated or rising streptococcal antibody titers (usually
>200 units).
9. Which are the three situations where the Jones criteria
cannot be applied to diagnose acute rheumatic fever?
Three notable situations where the Jones criteria cannot
be strictly used to diagnose rheumatic fever are the
following:
1. Patients presenting with chorea (St. Vitus dance):
Chorea occurs late and can sometimes be the only
clinical manifestation of rheumatic fever.
2. Patients with indolent carditis: In those presenting
late to medical attention (i.e. months after the onset
of rheumatic fever), there may be insufficient clinical
evidence to fulfill the Jones criteria.
3. To diagnose a recurrent attack of rheumatic fever in
patients already suffering from preexisting significant
rheumatic heart disease.
10. What is Jaccoud’s arthritis?
Jaccoud’s arthritis is a rare form of chronic arthritis
sometimes, occurring after attacks of acute rheumatic
fever. It is characterized by erosion of the metacarpal
heads and ulnar deviation of the fingers of hand.
11. How will you distinguish subcutaneous nodules of
rheumatic fever from that of rheumatoid arthritis?
Both rheumatic and rheumatoid nodules are painless
and mobile. Both are located in the subcutaneous tissues
on the extensor aspect of the elbows (most frequent
site), knees, ankles, occiput, knuckles and the spine of
vertebrae.
The rheumatic nodules are smaller (up to 5 mm) and
they may persist for weeks. But the rheumatoid nodules
are larger (1 to 2 cm) and they may persist for longer
duration, i.e. months to years.