Acute Rheumatic Fever (ARF); Let’s Think Beyond Old Believes! A Simple Reasoning Behind a Huge Fact

Abstract

Acute rheumatic fever (ARF) is historically defined as an abnormal immunologic reaction secondary to streptococcal infection. Aschoff’s bodies were suggested as pathognomonic findings in endomyocardial biopsies in 1904 by Ludwig Aschoff. Medical terminology of rheumatic heart diseases widely used interchangeably for any valvular or myocardial diseases for decades attributed to the kingdom of streptococcus associated heart attacks as the sole rheumatic diseases centuries ago. When the number of all rheumatic conditions were less than two or three. Considering to the friable connective tissue of valvular leaflets, this fact may make heart valves vulnerable in rather non-ARF rheumatic diseases. Before discovering conditions with potential valvular involvement during last 60 years, possibly most of them were ascribed to ARF-induced rheumatic heart disease and being managed accordingly. Critical issue in ascribing a diagnostic tool (Aschoff’s body) as a pathognomonic is domination on all mimicking conditions and full clinical expertise on all aspects of updated medicine. We think that most cases of so-called ARF may actually be diseases other than ARF and we should be careful in labeling patients with joint or valvular heart diseases as ARF. Remarkable decrease in incidence of ARF itself may be in part due to training and worldwide distribution of modern rheumatologist with more precise diagnoses.