Clinical, laboratory and epidemiological characteristics of patients with acute rheumatic fever and ultimate diagnosis of acute rheumatic fever

Objective: The epidemiological characteristics, risk factors, diagnostic criteria, treatment modalities, complication status, recurrence status, clinical and laboratory characteristic of ARF patiens who were referred to our hospital Pediatric Cardiology Department between 2012-2017 will retrospectively evalauted. The major and minor criteria used in diagnosis will be determined. In this way, it is aimed to reduce the morbidity and mortality of children with early diagnosis and treatment. By the evalatuation of final diagnosis of patients who admitted with pre-diagnosed with ARF; it is aimed to raise the level of consciousness about diseases associate with ARF-like symptoms. Materials and Methods: We retrospectively reviewed the data of 166 patients who received an acute rheumatic fever diagnosis and 51 patients who did not have acute rheumatic fever diagnosis that admitted with pre-diagnosed with ARFbetween January 2012 and December 2017 in the Department of Pediatric Cardiology of Dicle University Medical Faculty Hospital. Findings/Results: Patients diagnosed with ARF are between the ages of 5 and 18 (mean 12.08±2.72).Patients who come with pre-diagnose as ARF and do not have ARF diagnosis are between the ages of 3 and 17 (mean 11.02±3.76). 51.2% were male and 48.8% were female between 166 ARF patients who participated in the study. Of the 51 non-ARF patients, 49% were male and 51% were female. When the places where ARF patients live are evaluated, 53% of the patients were living in the provincial centers, 37.3% were in the district centers and 9.6% were living in the villages. The majority of patients who have applied with ARF attack have come in December (15,6 %), January (13,8 %) and February (13,2 %). When you look at the cities where ARF patients come from; 42.8% patients were from Diyarbakır and 57.2% of patients were from other cities of Southeastern region of Turkey. It was seen that the most common complaint was isolated joint pain and / or swelling with 50.6% in ARF patients. 91.5% of the ARF patients were the first diagnosis, while the remaining 8.5% were recurrency of ARF. In our ARF patients, 94.6% had carditis, 76.5% had arthritis (54.2% polyarthritis, 10.2% monoarthritis, 67.5% polyarthritis), 4.2% had korea, 1.8% had eritema marginatum and 0.6% had subcutaneous nodule. As minor criteria of ARF, 65% had AFR positivity, 30.7% had fever, 36.7 had PR elavation and 0% had monoarthralis. 25.3% of ARF patients in our study were found to have a major criteria at the time of admission, 72.3% two major criteria, 1.8% three major criteria, and 0.6% four major criteria. When the first echocardiographies of the patients are taken into consideration; 91.6% had mitral insufficiency, and 45.8% aortic insufficiency respectively. There was no significant relationship between carditis severity,age, gender, place of arrival, and acute phase reactants. Conclusion: Our study has shown that patients with anacute rheumuatic fever pre-diagnosis need to undergo differential diagnosis with many diseaseswhich have similar complaints and findings. Carditis was the most common major finding in acute rheumatic fever patients.Acute phase reactant positivity was found as the most frequent minor finding. Regarding the incidence of valve involvement, the most frequently involved mitral valve was followed by aortic valve. Within the major criteria coexisting, carditis-arthritis combination was most common. Elevation of ALT, frequency of monoarthritis, and severity of valve involvement were found to be high in patients who has recurrency. Furthermore, the number of improvement in valve deficiencies after treatment was seen to be low in our patients. Monoarthritis was considered the major finding for the Jones criteria which revised by the American Heart Academy in 2015.In our study, monoarthritis (10.2%) was accepted as a major criteria. Key Keyword: Acute rheumatic fever (ARF), carditis, arthritis, recurrence