What Things Do You Know about Rheumatic?
 What is Rheumatic?
Rheumatic is an inflammatory disease that occurs following a Streptococcus pyogenes infection, such as streptococcal pharyngitis or scarlet fever. Rheumatic can involve brain, joints, heart, and skin. The cause of this disease is antibody cross-reactivity. Acute rheumatic may happen in percentage of 20%, commonly appears in children between the ages of 6 and 15.

 What is The Diagnoses for a Rheumatic?
According to Jones criteria, 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.
a. Major Criteria
- Polyarthritis: A temporary migrating inflammation of the large joints, usually starting in the legs and migrating upwards.
- Carditis: Inflammation of the heart muscle which can manifest as congestive heart failure with shortness of breath, pericarditis with a rub, or a new heart murmur.
- Subcutaneous nodules: Painless, firm collections of collagen fibers over bones or tendons. They commonly appear on the back of the wrist, the outside elbow, and the front of the knees.
- Erythema marginatum: A long lasting rash that begins on the trunk or arms as macules and spreads outward to form a snake like ring while clearing in the middle. This rash never starts on the face and it is made worse with heat.
- Sydenham's chorea (St. Vitus' dance): A characteristic series of rapid movements without purpose of the face and arms. This can occur very late in the disease for at least three months from onset of infection.
b. Minor criteria
- Fever of 38.2–38.9 °C (101–102 °F)
- Arthralgia: Joint pain without swelling (Cannot be included if polyarthritis is present as a major symptom)
- Raised erythrocyte sedimentation rate or C reactive protein
- Leukocytosis
- ECG showing features of heart block, such as a prolonged PR interval (Cannot be included if carditis is present as a major symptom)
- First Degree AV-Block
- Previous episode of rheumatic fever or inactive heart disease

c. Other Signs and Symtomps
- Abdominal pain
- Nose bleeds
- Preceding streptococcal infection: recent scarlet fever, raised antistreptolysin O or other streptococcal antibody titre, or positive throat culture.
d. Other Criterias
- Wegener's Granulomatosis – 1990 (now known as Granulomatosis with Polyangiitis)
- Takayasu Arteritis
- SclerodermaPolyarteritis
- Nodosa
- Osteoarthritis of the Knee
- Osteoarthritis of the Hand
- Osteoarthritis of the Hip
 Chronic rheumatic conditions
- Rheumatoid Arthritis
Rheumatoid Arthritis is a chronic systemic disease that affects the joints, connective tissues, muscle, tendons, and fibrous tissue. It tends to to strike during the most productive years of adulthood, between the ages of 20 and 40, and is a chronic disabling condition often causing pain and deformity.
- Osteoarthritis
Osteoarthritis is a degenerative joint disease, which mainly affects the articular cartilage. It is associated with ageing and will most likely affect the joints that have been continually stressed throughout the years including the knees, hips, fingers, and lower spine region.
- Osteoporosis
Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures of the hip, spine, and wrist.
- Spinal Disorders
Spinal Disorders include trauma, mechanical injury, spinal cord injury, inflammation, infection, and tumour. About 80–85% of back pain episodes have no known cause.
- Severe limb trauma
Severe limb trauma that can result in permanent disability includes amputations, fractures, crushing injuries, dislocations, open wounds, blood vessel and nerve injuries.
 Prevention
There is no cure for rheumatic fever once it has developed, although medications can be used to eradicate any remaining streptococcal infection and to control some of the symptoms.
Treatment consists of antibiotics, usually penicillin, bed rest, and aspirin or steroids. Aspirin may reduce fever, and relieve joint pain and swelling. Corticosteroids may be used if aspirin is inadequate.
Fortunately, recurrent streptococcal infections can be prevented very effectively with penicillin (Erythromycin may be substituted).
To prevent recurrent rheumatic fever in persons who have already had one episode, monthly injections of a long-lasting preparation of penicillin can be effective.
The risk of recurrence is higher in patients in whom the cardiac manifestations of acute rheumatic fever do not resolve, and those patients should receive antibiotic prophylaxis (protection) prior to dental or surgical procedures.
Physicians do not know how to slow the process that damages the heart valves. Therefore, preventing rheumatic fever is the most effective way to "treat" the disease.
The initial episode of rheumatic fever usually can be prevented by early treatment of streptococcal pharyngitis (strep throat) with antibiotics.
 Is there Any Treatment for Rheumatic?
The management of acute rheumatic fever is geared toward the reduction of inflammation with anti-inflammatory medications such as aspirin or corticosteroids. Individuals with positive cultures for strep throat should also be treated with antibiotics. For instant, you can take some Aspirin. Aspirin is the drug of choice and should be given at high doses of 100 mg/kg/day. One should watch for side effects like gastritis and salicylate poisoning. In children and teenagers, the use of aspirin and aspirin-containing products can be associated with Reye's syndrome, a serious and potentially deadly condition. You have to consider the risk, benefits and alternative treatments in using this drug for children and teenagers. You also have to pay attention in using Ibuprofen for pain and discomfort and also corticosteroids for moderate to severe inflammatory reactions manifested by rheumatic fever, especially for children and teenagers. Steroids are reserved for cases where there is evidence of involvement of heart. The use of steroids may prevent further scarring of tissue and may prevent development of sequelae such as mitral stenosis. Monthly injections of longacting penicillin must be given for a period of five years in patients having one attack of rheumatic fever. If there is evidence of carditis, the length of Penidure therapy may be up to 40 years. Another important cornerstone in treating rheumatic fever includes the continual use of low-dose antibiotics (such as penicillin, sulfadiazine, or erythromycin) to prevent recurrence.
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