Acute Rheumatic Fever Cases Presented with Enthesitis: A Different View on Acute Rheumatic Fever

Abstract

Background: Acute rheumatic fever (ARF) is a non-suppurative inflammatory disease that develops after group A Beta hemolytic streptococcal pharyngitis, primarily involving the heart, joint, central nervous system, skin and subcutaneous tissue. Today, Jones criteria; that were modified in 2015, are used for diagnosis. Our aim in this study is to examine the patients diagnosed with acute rheumatic fever in our clinic and presented with enthesitis.
 Methods: The type of study is case report. Five patients who were admitted to the Pediatric Rheumatology Clinic of Selcuk University Faculty of Medicine were diagnosed with acute rheumatic fever and presented with enthesitis, between 2017- 2019 were examined retrospectively. Their demographic, clinical laboratory and echocardiographic data were examined. The presence of enthesitis in all patients was established with one or more of the options of clinical examination, ultrasonography, magnetic resonance imaging, and/or orthopedics opinion. 
 Results: While the clinic of the patients improved with the treatment for enthesitis, acute phase reactants did not fall and additional clinical findings appeared. Our observations suggested that acute rheumatic fever could apply to us not only with arthritis and arthralgia, but also with the enthesitis clinic. Therefore, we think that if the laboratory data are compatible among the differential diagnoses in patients presenting with enthesitis, acute rheumatic fever should also be considered, and careful physical examination and echocardiography should be performed for this purpose.
 Conclusion: In relation to the pathogenesis of the rheumatological diseases, new clinical situations are emerging day by day, and in this way, the diseases are better understood and classified. In conclusion, we think that ARF can be encountered not only with arthritis and arthralgia but also with enthesitis clinics, and echocardiographic imaging should not be ignored in patients with enthesitis clinic who have high acute phase reactants and who do not meet the enthesitis-related juvenile idiopathic arthritis criteria.