Children and adolescents
Acute rheumatic fever
Migratory arthritis, carditis or chorea 2–4 weeks after group A streptococcal pharyngitis.
What to look for
- Major Jones criteria: carditis (clinical or on echo), arthritis, chorea, erythema marginatum, subcutaneous nodules
- Low-risk vs moderate/high-risk populations use different joint criteria (AHA 2015)
- Evidence of recent group A strep: ASO, anti-DNase B, or culture or rapid antigen
What to do
- Send ASO, anti-DNase B, ESR, CRP, CBC and an ECG. Get an echocardiogram.
- Treat strep with penicillin and plan secondary prophylaxis. Coordinate with cardiology.
About this urgency level
Early specialist assessment changes outcomes. Send the usual workup with the referral, but don't hold the referral while waiting for results.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.