Jaccoud’s arthritis

Jaccoud’s arthritis is a deforming arthritis of the small joints of the hand and feet secondary to rheumatic fever. Usually rheumatic fever involves the major joints and is a non-deforming arthritis. Jacoud’s arthritis is due to peri-articular fibrosis and it is called as a correctable deformity, unlike the deformity in rheumatoid arthritis which is fixed.

Major manifestations of rheumatic fever

Polyarthritis – usually migratory, fleeting and flitting type of arthritis; fleeting means transient; flitting means jumping from one joint to another

Carditis – though it is a pancarditis, predominant manifestation is valvular regurgitation

Chorea – Sydenham’s chorea. Chorea being a late manifestation, is seldom associated with arthritis, which is an early manifestation. (Imagine the trouble for a patient with acute arthritis and chorea!).

Erythema marginatum

Subcutaneous nodules – usually seen over the extensor aspect, around the the elbow, knee and over the scalp. Subcutaneous nodules are usually associated with carditis – nodules under the skin, nodules in the heart (Aschoff nodules – a pathological finding in rheumatic fever). Subcutaneous nodules in rheumatic fever are painless and freely mobile.

Post streptococcal reactive arthritis

Post streptococcal reactive arthritis (PSRA) has a lower latency of about 1 week after the streptococcal infection, unlike the usual delay of about three weeks with rheumatic fever. PSRA responds poorly to treatment unlike rheumatic fever. It is often difficult to differentiate PSRA from rheumatic fever without carditis.