title: Do rates of arthritis and chorea predict the incidence of acute rheumatic fever?
abstract: BACKGROUND
  Acute rheumatic fever (ARF), a major cause of acquired heart disease worldwide, remains a significant public health problem. However, the precise incidence of ARF in Africa, where a large number of cases occur, remains unknown. We hypothesize that focused attention on non-cardiac features of ARF, namely joint manifestations and chorea, might enhance its detection in settings with limited resources.
  
  
  METHODS
  This hypothesis was tested by reviewing the medical records at Vanderbilt Children's Hospital from 1998 to 2008. In addition, an extensive literature review of published studies was performed to assess rates of joint findings or chorea in confirmed cases of ARF.
  
  
  RESULTS
  Fifty-nine new cases of ARF were diagnosed in children at Vanderbilt from 1998 to 2008. Of these cases, 91% presented with joint manifestations or chorea, and 80% satisfied major Jones criteria findings of polyarthritis or chorea. These findings are consistent with literature published from our region and internationally.
  
  
  CONCLUSIONS
  Most patients presenting with ARF have either joint symptoms or chorea, features that could be recognized by community health workers and individuals with limited medical training. The referral of patients presenting with these manifestations for further evaluation might improve detection rates of ARF in resource-limited countries and lead to improved estimates of disease burden.
authors.affiliation: Department of General Pediatrics, Divisions of Pediatric Cardiology, Neonatology and Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Tunks
authors.affiliation: Department of General Pediatrics, Divisions of Pediatric Cardiology, Neonatology and Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Mario A
authors.initials: MA
authors.lastname: Rojas
authors.affiliation: Department of General Pediatrics, Divisions of Pediatric Cardiology, Neonatology and Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Edwards
authors.affiliation: Department of General Pediatrics, Divisions of Pediatric Cardiology, Neonatology and Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Liske
mesh_terms: D000293:Adolescent; D000349:Africa / Q000453:epidemiology; D001168:Arthritis / Q000150:complications / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D002819:Chorea / Q000150:complications / Q000453:epidemiology*; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012213:Rheumatic Fever / Q000175:diagnosis / Q000453:epidemiology*; D013714:Tennessee / Q000453:epidemiology