The Difference Between Rheumatic Fever and Rheumatoid Arthritis

Written by Yang Ya Meng
Rheumatology
Updated on September 03, 2024
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Most patients with rheumatoid arthritis primarily exhibit symptoms related to the joints. Mainly affected are the symmetrical small joints of both hands, including both wrists, both palmar digital joints, and both proximal interphalangeal joints. In addition, patients with rheumatoid arthritis often have elevated rheumatoid factor, anti-CCP antibodies, and AKA antibodies. During the acute phase of joint disease, there is a marked increase in inflammatory markers, which is a major manifestation of rheumatoid arthritis. Patients with rheumatic fever, aside from joint pain, may also have heart valve disorders, such as mitral stenosis, and some patients may develop skin lesions, commonly erythema nodosum. Most importantly, patients with rheumatic conditions often show a significant increase in anti-streptolysin O.

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Written by Yang Ya Meng
Rheumatology
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Difference between Rheumatic Fever and Rheumatoid Arthritis

The key difference between rheumatic fever and rheumatoid arthritis primarily lies in the fact that patients with rheumatic fever, besides exhibiting symptoms such as joint pain, also develop cardiac and dermatological manifestations. Patients with rheumatic fever may experience mitral stenosis and symptoms like erythema on the skin. Moreover, the examination of antibodies in rheumatic fever patients mainly shows an elevation in anti-streptolysin O antibody. In contrast, patients with rheumatoid arthritis typically display elevated rheumatoid factor, anti-CCP antibodies, and anti-AKA antibodies, and they seldom have skin or cardiac manifestations. Therefore, to differentiate rheumatic fever from rheumatoid arthritis, one can test for anti-streptolysin O and rheumatoid factor, and further conduct an echocardiogram to determine any cardiac involvement.

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Written by Yang Ya Meng
Rheumatology
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How to treat rheumatic fever arthritis?

Rheumatic fever joint pain initially can be treated with anti-inflammatory and analgesic medications. The most commonly used are non-steroidal anti-inflammatory drugs (NSAIDs), such as slow-release diclofenac sodium tablets. Since rheumatic fever is triggered by a streptococcal infection, if the streptococcus is not controlled, joint pain may reoccur. Therefore, fundamentally, an adequate course of anti-infection treatment is also needed. In the acute phase of rheumatic fever, antibiotics such as penicillin or second-generation cephalosporins can be used for a 10-14 day treatment. Subsequently, treatment may require sequential benzathine penicillin for possibly up to six months or more than a year. (Please use medications under the guidance of a doctor.)

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Written by Liu Li Ning
Rheumatology
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Rheumatic fever is not caused by a bacterium, but is a complication of a streptococcal infection.

Rheumatic fever is associated with Group A beta-hemolytic streptococcal infection and is a systemic inflammatory disease. The detailed pathogenesis is not yet very clear. Common clinical manifestations include joint pain, subcutaneous nodules, erythema marginatum, fever, chorea, and carditis. The characteristic of joint pain is that it generally does not leave joint deformities, and presents as migratory pain in the large joints of the limbs. Carditis can affect the heart valves and endocardium, primarily commonly involving the mitral or tricuspid valves. During the acute phase, penicillin antibiotics are needed for anti-infective treatment.

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Written by Yang Ya Meng
Rheumatology
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Treatment of acute rheumatic fever

The treatment of rheumatic fever includes general treatment, where patients are advised to rest in bed. The second is the use of antibiotics, aimed at eliminating streptococcal infections to prevent recurrent attacks of rheumatic fever. The third is anti-rheumatic treatment, with the preferred choice being non-steroidal anti-inflammatory drugs, such as sustained-release diclofenac sodium tablets. If the patient's rheumatic fever affects the heart, corticosteroid treatment is also required. In addition, to assist in the reduction of corticosteroids, some immunosuppressants need to be added, such as methotrexate and leflunomide, which help control the condition. For the treatment of complications of rheumatic disease, such as concurrent lung infection, antibiotic treatment should also be considered. (The use of medication should be under the guidance of a professional doctor.)

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Written by Yang Ya Meng
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What should be paid attention to in the diet for rheumatic fever?

For patients with rheumatism, the general dietary rule is to follow a light diet, reduce spicy and greasy foods, and avoid foods that are too warm and dry. Specifically, vegetables like celery, coriander, leeks, seaweed, and shiitake mushrooms should be reduced in consumption because they may cause photosensitivity and worsen rheumatism. At the same time, meats such as lamb, dog meat, and beef are considered too warming and nourishing, and may also trigger the worsening of rheumatism, so their consumption should also be minimized. Similarly, seafood like shrimp, crab, and sea cucumber, which are high in protein, might cause allergic reactions in patients with rheumatism, so their intake should be minimized as well.