Características clínicas e demográficas de 193 pacientes com febre reumática

• Autor(a) principal: Terreri, Maria Teresa Ramos Ascensão [UNIFESP]
• Data de Publicação: 2006
• Outros Autores: Caldas, Álvaro Manuel [UNIFESP], Len, Claudio Arnaldo [UNIFESP], Ultchak, Fabio [UNIFESP], Hilário, Maria Odete Esteves [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0482-50042006000600005; http://repositorio.unifesp.br/handle/11600/3431
• topic: rheumatic fever; subclinical carditis; atypical arthritis; chorea; febre reumática; cardite subclínica; artrite atípica; coréia

OBJECTIVE: the aim of this study was to analyze the demographic and clinical characteristics of patients with acute rheumatic fever (ARF), followed between 1995 and 2005. METHODS: we retrospectively reviewed the medical records of 193 patients with ARF diagnosed according to the revised Jones criteria (1992). Only the patients that initiated the follow-up in the first two months of onset were included, in order to reduce the diagnostic mistake. Demographic, clinical and laboratorial data and echocardiographic abnormalities were considered. RESULTS: four out of 193 (2.1%) were younger than 5 years old. The most frequent clinical manifestation was arthritis (70.5%) followed by carditis (50.8%) and chorea (35.2%). Atypical arthritis occurred in 64 (33.2%) patients characterized by monoarthritis (10.9%), or involvement of unusual joints (59.4%), or duration longer than 6 weeks (18.8%), or poor response to salicylates (10.9%). Regarding the cardiac involvement we observed subclinical carditis in 19% of the patients. Clinical carditis presented most frequently as mitral involvement (regurgitation) (96.9%). Chorea was present in 35% of the patients. Regarding lab work, anemia (p=0.01), erythrocyte sedimentation rate > 100 mm (p= 0.04) and elevation of alpha1 acid glycoprotein (p=0.04) were statistically more frequent in patients with carditis compared to patients without this involvement. Fifteen percent of patients experienced recurrences. CONCLUSION: 1) rheumatic fever is still prevalent in our environment; 2) atypical arthritis is a common finding and must be taken into account in the ARF diagnosis; 3) subclinical carditis must be considered in our patients; 4) the frequency of Sydenham's chorea is higher than that described in the literature; 5) recurrences are frequent in our patients.