title: Acute rheumatic fever in adults: a resurgence in the Hasidic Jewish community.
abstract: OBJECTIVE
  To describe a series of adults diagnosed with acute rheumatic fever (ARF).
  
  
  METHODS
  Retrospective chart review of 14 patients age > 18 years with suspected ARF between 1990 and 1994 in a private rheumatology practice setting. Four additional patients treated at our medical center were included in the study.
  
  
  RESULTS
  Twelve patients met Jones criteria for rheumatic fever and were included in the study. Of these, only 3 had a childhood history of rheumatic fever. All had recent onset of arthritis and a history of antecedent sore throat. Only 4 patients, however, had throat cultures positive for B-hemolytic streptococcus. Nine patients were Hasidic Jews. Four patients had carditis. One patient had erythema marginatum, while chorea and subcutaneous nodules were not seen. Nine patients improved taking nonsteroidal antiinflammatory drugs or acetylsalicylic acid; 3 required steroid treatment to control severe arthritis.
  
  
  CONCLUSIONS
  Our clinical experience suggests that ARF occurs frequently, especially among Hasidic Jewish adults. Due to the disabling nature of the arthritis and the significant incidence (33%) of carditis, strict adherence to penicillin prophylaxis guidelines is indicated.
authors.affiliation: Department of Medicine, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
authors.forename: J
authors.initials: J
authors.lastname: Feuer
authors.forename: H
authors.initials: H
authors.lastname: Spiera
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004890:Erythema / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007585:Jews; D008297:Male; D009205:Myocarditis / Q000188:drug therapy / Q000208:ethnology / Q000209:etiology; D009518:New York / Q000453:epidemiology; D010612:Pharyngitis / Q000382:microbiology; D010614:Pharynx / Q000382:microbiology; D012189:Retrospective Studies; D012213:Rheumatic Fever / Q000188:drug therapy / Q000208:ethnology* / Q000209:etiology; D013256:Steroids; D013290:Streptococcal Infections / Q000209:etiology; D013291:Streptococcus / Q000302:isolation & purification
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013256:Steroids