38 Rheumatic Fever (Poststreptococcal Reactive Arthritis)


38 Rheumatic Fever (Poststreptococcal Reactive Arthritis)

Spindler-Thiele, S., Lingg, G.

Pathoanatomy and Clinical Symptoms

Rheumatic fever is rarely seen today. The infection with β-hemolytic streptococci, group A, leads to a systemic inflammatory reaction via a secondary immunopathogenesis. In 20–70% of cases, there is a carditis and endocarditis, and in 50–80%, there is a recurrent polyarthritis corresponding to classic reactive arthritis. Sydenham chorea seldom appears, and Jaccoud arthropathy, which is now rare, develops as a result of multiple episodes of polyarthritis.


Two forms of disease progression have been described:

  • Acute articular rheumatism becomes manifest in several joints either simultaneously or in quick succession as migrating polyarthritis and usually affects the ankles and knees. Aside from soft-tissue swelling, only discrete periarticular osteopenia can be seen in radiographs.

  • Jaccoud arthritis, a nonerosive arthropathy that is referred to as chronic rheumatic fever and chronic postrheumatic polyarthritis, leads to characteristic signs in the hands ( Table 38.1 , Figs. 38.1a, 38.2 ).

Fig. 38.1a, b Schematic drawing of different forms of erosions and joint destruction. a Hooklike erosions are extra-articular, usually metaphyseal. They are observed in Jaccoud arthritis, rheumatic fever, and lupus erythematosus. b Marginal erosions are seen in rheumatoid arthritis. c Epiphyseal osteonecroses are characteristic of lupus erythematosus.

Table 38.1 Radiographic signs of Jaccoud arthritis

  • Painless and elastic malalignments:

    • Ulnar deviation and flexion in the metacarpophalangeal joints, especially of fingers IV and V

    • Hyperextension in the interphalangeal joints

  • Discrete periarticular osteopenia

  • Narrowing of the joint space is rare (usually as a result of subluxation)

  • Hooklike erosions:

    • Develop rarely and only in late stages

    • On the metaphyses and radiopalmar on the metacarpal heads

  • No lesion in the carpal and interphalangeal joints

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Jul 21, 2020 | Posted by in MUSCULOSKELETAL IMAGING | Comments Off on 38 Rheumatic Fever (Poststreptococcal Reactive Arthritis)

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