4th Pediatric Infectious Diseases Conference
 
 
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Rheumatic Heart disease
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Specialist Answers
Question
Why joint pain in acute rheumatic fever is fleeting? 2)WHY ABNORMAL MOVEMENT OF RHEUMATIC CHOREA DISAPPEAR IN SLEEP? 3Differential diagnosis of fleeting joint pain which i know are only two 1-LYME DISEASE 2GONOCOCCAL ARTHRITIS. Are there more d/d? Of these Lyme not seen in India Gonococcal is very rare hence can we conclude that fleeting joint pain occurs in rheumatic fever in our country?
Answer
1. There has been no satisfactory explanation for fleeting joint pains in ARF.

2. All basal ganglia affection - chorea, tremors , rigidity reduce during sleep. Additionally in rheumatic chorea there is an imbalance in dopermergic vs Gaba levels with relative increase in former leading to chorea. During sleep GABA production is increased with decrease in dopamine.

3.There are many causes of fleeting joint pains including meningococcemia,leukemia, Rocky mountain...., Lymes , gonococcal, stills disease( systemic onset JRA)early stages of SLE, Honech scholein purpura. Hence fleeting joint pains should be interpreted with other clinical findings and is not pathognomonic of rheumatic fever alone.
 
 
 
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