What allergy medicine can i take with afib

Rheumatic fever can be prevented by effectively and promptly treating strep throat with antibiotics.[34]

In those who own previously had rheumatic fever, antibiotics in a preventative manner are occasionally recommended.[34] As of 2017 the evidence to support endless term antibiotics in those with underlying disease is poor.[35]

The American Heart Association suggests that dental health be maintained, and that people with a history of bacterial endocarditis, a heart transplant, artificial heart valves, or «some types of congenital heart defects» may wish to consider long-term antibiotic prophylaxis.[36]


Epidemiology

About 33 million people are affected by rheumatic heart disease with an additional 47 million having asymptomatic damage to their heart valves.[35] As of 2010 globally it resulted in 345,000 deaths, below from 463,000 in 1990.[41]

In Western countries, rheumatic fever has become fairly rare since the 1960s, probably due to the widespread use of antibiotics to treat streptococcus infections.

While it has been far less common in the United States since the beginning of the 20th century, there own been a few outbreaks since the 1980s.[42] The disease is most common among Indigenous Australians (particularly in central and northern Australia), Māori, and Pacific Islanders, and is also common in Sub-Saharan Africa, Latin America, the Indian Subcontinent, the Middle East, and North Africa.[43]

Rheumatic fever primarily affects children between ages 5 and 17 years and occurs approximately 20 days after strep throat.

In up to a third of cases, the underlying strep infection may not own caused any symptoms.

The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3%. The incidence of recurrence with a subsequent untreated infection is substantially greater (about 50%).[44] The rate of development is far lower in individuals who own received antibiotic treatment. Persons who own suffered a case of rheumatic fever own a tendency to develop flare-ups with repeated strep infections.

The recurrence of rheumatic fever is relatively common in the absence of maintenance of low dose antibiotics, especially during the first three to five years after the first episode.

Recurrent bouts of rheumatic fever can lead to valvular heart disease. Heart complications may be long-term and severe, particularly if valves are involved. In countries in Southeast-Asia, sub-saharan Africa, and Oceania, the percentage of people with rheumatic heart disease detected by listening to the heart was 2.9 per 1000 children and by echocardiography it was 12.9 per 1000 children.[45][46][47][48]


References

Pathophysiology of rheumatic heart diseaseDeaths from rheumatic heart disease per million persons in 2012

  0–7

  8–14

  15–20

  21–25

  26–32

  33–38

  39–45

  46–52

  53–63

  64–250

Disability-adjusted life year for rheumatic heart disease per 100,000 inhabitants in 2004.[40]

  no data

  less than 20

  20–40

  40–60

  60–80

  80–100

  100–120

  120–140

  140–160

  160–180

  180–200

  200–330

  more than 330

  • have a severe allergy to milk proteins.

    Enquire your healthcare provider if you are not sure.

  • ANORO ELLIPTA is used as 1 inhalation 1 time each day to improve symptoms of COPD for better breathing and to reduce the number of flare-ups (the worsening of your COPD symptoms for several days).
  • ANORO ELLIPTA is not used to treat sudden symptoms of COPD. Always own a save inhaler (an inhaled, short-acting bronchodilator) with you to treat sudden symptoms of COPD. If you do not own a save inhaler, contact your healthcare provider to own one prescribed for you.
  • ^ abKumar, Vinay; Abbas, Abul K; Fausto, Nelson; Mitchell, Richard N (2007).

    Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 403–6. ISBN .

  • ^ abcStanevicha, V; Eglite, J; Sochnevs, A; Gardovska, D; Zavadska, D; Shantere, R (2003). «HLA class II associations with rheumatic heart disease among clinically homogeneous patients in children in Latvia». Arthritis Research & Therapy. 5 (6): R340–R346. doi:10.1186/ar1000. PMC 333411. PMID 14680508.
  • ^«Streptococcus pyogenes – Pathogen Safety Data Sheets».

    Public Health Agency of Canada. 18 February 2011. Archived from the original on 17 January 2017. Retrieved 15 April 2017.

  • ^Faé KC, da Silva DD, Oshiro SE, et al. (May 2006). «Mimicry in recognition of cardiac myosin peptides by heart-intralesional T cell clones from rheumatic heart disease». J. Immunol. 176 (9): 5662–70. doi:10.4049/jimmunol.176.9.5662. PMID 16622036.
  • ANORO ELLIPTA should not be used in children. It is not known if ANORO ELLIPTA is safe and effective in children.
  • have eye problems such as glaucoma.

    ANORO ELLIPTA may make your glaucoma worse.

  • ^Caldas, AM; Terreri, MT; Moises, VA; Silva, CM; Len, CA; Carvalho, AC; Hilário, MO (2008). «What is the true frequency of carditis in acute rheumatic fever? A prospective clinical and Doppler blind study of 56 children with up to 60 months of follow-up evaluation». Pediatric Cardiology. 29 (6): 1048–53. doi:10.1007/s00246-008-9242-z. PMID 18825449.
  • ^ abcLee, KY; Rhim, JW; Kang, JH (March 2012).

    What allergy medicine can i take with afib

    «Kawasaki disease: laboratory findings and an immunopathogenesis on the premise of a «protein homeostasis system»». Yonsei Medical Journal. 53 (2): 262–75. doi:10.3349/ymj.2012.53.2.262. PMC 3282974. PMID 22318812.

  • are pregnant or plan to become pregnant. It is not known if ANORO ELLIPTA may harm your unborn baby.
  • are allergic to umeclidinium, vilanterol, or any of the ingredients in ANORO ELLIPTA.

    See «What are the ingredients in ANORO ELLIPTA?» under for a finish list of ingredients.

  • atropine
  • have heart problems.
  • have liver problems.
  • anticholinergics (including tiotropium, ipratropium, aclidinium)
  • ANORO ELLIPTA is not for the treatment of asthma. It is not known if ANORO ELLIPTA is safe and effective in people with asthma.
  • have thyroid problems.
  • have seizures.
  • ^Quinn, RW (1991). «Did scarlet fever and rheumatic fever exist in Hippocrates’ time?». Reviews of Infectious Diseases. 13 (6): 1243–4. doi:10.1093/clinids/13.6.1243. PMID 1775859.
  • ^GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators.

    (8 October 2016). «Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015». Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.

  • are breastfeeding or plan to breastfeed. It is not known if the medicines, umeclidinium and vilanterol, in ANORO ELLIPTA pass into your breast milk and if they can harm your baby.
  • have asthma.
  • have diabetes.
  • ^Kaplan, MH; Bolande, R; Rakita, L; Blair, J (1964). «Presence of Bound Immunoglobulins and Complement in the Myocardium in Acute Rheumatic Fever.

    Association with Cardiac Failure». The New England Journal of Medicine. 271 (13): 637–45. doi:10.1056/NEJM196409242711301. PMID 14170842.

  • have high blood pressure.
  • ^Guilherme, L; Kalil, J; Cunningham, M (2006). «Molecular mimicry in the autoimmune pathogenesis of rheumatic heart disease». Autoimmunity. 39 (1): 31–9. doi:10.1080/08916930500484674. PMID 16455580.
  • ^Ashby, Carol Turkington, Bonnie Lee (2007). The encyclopedia of infectious diseases (3rd ed.). New York: Facts On File. p. 292. ISBN . Archived from the original on 21 November 2015.
  • have prostate or bladder problems, or problems passing urine.

    ANORO ELLIPTA may make these problems worse.

  • ^ abCotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: Elsevier Saunders. ISBN . Archived from the original on 10 September 2005.
  • ^Abbas, Abul K.; Lichtman, Andrew H.; Baker, David L.; et al. (2004). Basic immunology: functions and disorders of the immune system (2 ed.). Philadelphia, Pennsylvania: Elsevier Saunders. ISBN .
  • ^ abSpinks, A; Glasziou, PP; Del Mar, CB (5 November 2013).

    «Antibiotics for sore throat». The Cochrane Database of Systematic Reviews. 11 (11): CD000023. doi:10.1002/14651858.CD000023.pub4. PMC 6457983. PMID 24190439.

  • ^ ab«Rheumatic Fever 1997 Case Definition». cdc.gov. 3 February 2015. Archived from the original on 19 February 2015. Retrieved 19 February 2015.
  • ^ abBrice, Edmund A. W; Commerford, Patrick J. (2005). «Rheumatic Fever and Valvular Heart Disease». In Rosendorff, Clive (ed.). Essential Cardiology: Principles and Practice.

    Totowa, New Jersey: Humana Press. pp. 545–563. doi:10.1007/978-1-59259-918-9_30. ISBN .

  • ^GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). «Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013». Lancet. 385 (9963): 117–171. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.
  • ^ abGBD 2015 Mortality and Causes of Death, Collaborators.

    (8 October 2016). «Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015». Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.

  • are allergic to milk proteins.
  • ^ abRoberts, S; Kosanke, S; Terrence Dunn, S; Jankelow, D; Duran, CM; Cunningham, MW (2001). «Pathogenic mechanisms in rheumatic carditis: Focus on valvular endothelium». The Journal of Infectious Diseases.

    183 (3): 507–11.

    What allergy medicine can i take with afib

    doi:10.1086/318076. PMID 11133385.

  • ^Kemeny, E; Grieve, T; Marcus, R; Sareli, P; Zabriskie, JB (1989). «Identification of mononuclear cells and T cell subsets in rheumatic valvulitis». Clinical Immunology and Immunopathology. 52 (2): 225–37. doi:10.1016/0090-1229(89)90174-8. PMID 2786783.
  • ^«rheumatic fever» at Dorland’s Medical Dictionary
  • ^ abcdefghijklmnopqrstuvwxyzaaabacMarijon, E; Mirabel, M; Celermajer, DS; Jouven, X (10 March 2012).

    «Rheumatic heart disease». Lancet. 379 (9819): 953–64. doi:10.1016/S0140-6736(11)61171-9. PMID 22405798.

  • antifungal or anti-HIV medicines
  1. ANORO ELLIPTA is not used to treat sudden symptoms of COPD.

    What allergy medicine can i take with afib

    Always own a save inhaler (an inhaled, short-acting bronchodilator) with you to treat sudden symptoms of COPD. If you do not own a save inhaler, contact your healthcare provider to own one prescribed for you.

  2. ANORO ELLIPTA is not for the treatment of asthma. It is not known if ANORO ELLIPTA is safe and effective in people with asthma.
  3. ANORO ELLIPTA is used as 1 inhalation 1 time each day to improve symptoms of COPD for better breathing and to reduce the number of flare-ups (the worsening of your COPD symptoms for several days).
  4. ANORO ELLIPTA should not be used in children.

    It is not known if ANORO ELLIPTA is safe and effective in children.

Do not use ANORO ELLIPTA if you:

  1. are allergic to umeclidinium, vilanterol, or any of the ingredients in ANORO ELLIPTA. See «What are the ingredients in ANORO ELLIPTA?» under for a finish list of ingredients.
  2. have a severe allergy to milk proteins. Enquire your healthcare provider if you are not sure.
  3. have asthma.

Before using ANORO ELLIPTA, tell your healthcare provider about every of your medical conditions, including if you:

  1. have eye problems such as glaucoma.

    ANORO ELLIPTA may make your glaucoma worse.

  2. have liver problems.
  3. have diabetes.
  4. have high blood pressure.
  5. have prostate or bladder problems, or problems passing urine. ANORO ELLIPTA may make these problems worse.
  6. have seizures.
  7. have thyroid problems.
  8. are allergic to milk proteins.
  9. are pregnant or plan to become pregnant. It is not known if ANORO ELLIPTA may harm your unborn baby.
  10. have heart problems.
  11. are breastfeeding or plan to breastfeed.

    It is not known if the medicines, umeclidinium and vilanterol, in ANORO ELLIPTA pass into your breast milk and if they can harm your baby.

Tell your healthcare provider about every the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. ANORO ELLIPTA and certain other medicines may interact with each other. This may cause serious side effects.

Especially tell your healthcare provider if you take:

  1. atropine
  2. anticholinergics (including tiotropium, ipratropium, aclidinium)
  3. antifungal or anti-HIV medicines

Know the medicines you take.

Hold a list of them to show your healthcare provider and pharmacist when you get a new medicine.

How does this medication work? What will it do for me?

Montelukast belongs to a group of medications known as leukotriene receptor antagonists. It is used to prevent and manage asthma symptoms and to relieve the symptoms of seasonal allergies, also known as seasonal allergic rhinitis or hay fever. It works by blocking the effects of leukotrienes, a substance produced by the body in response to certain "triggers" that cause narrowing and swelling of airways in the lungs. Montelukast generally starts to work within one day.

When used to prevent and manage asthma, it is significant to understand that montelukast should not be used to relieve an asthma attack once it has started.

People with asthma should always own their fast-acting asthma relief medication on hand to treat an asthma attack.

Your doctor may own suggested this medication for conditions other than the ones listed in these drug information articles. As well, some forms of this medication may not be used for every of the conditions discussed here. If you own not discussed this with your doctor or are not certain why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they own the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

  1. ANORO ELLIPTA is not used to treat sudden symptoms of COPD.

    Always own a save inhaler (an inhaled, short-acting bronchodilator) with you to treat sudden symptoms of COPD. If you do not own a save inhaler, contact your healthcare provider to own one prescribed for you.

  2. ANORO ELLIPTA is not for the treatment of asthma. It is not known if ANORO ELLIPTA is safe and effective in people with asthma.
  3. ANORO ELLIPTA is used as 1 inhalation 1 time each day to improve symptoms of COPD for better breathing and to reduce the number of flare-ups (the worsening of your COPD symptoms for several days).
  4. ANORO ELLIPTA should not be used in children. It is not known if ANORO ELLIPTA is safe and effective in children.

Do not use ANORO ELLIPTA if you:

  1. are allergic to umeclidinium, vilanterol, or any of the ingredients in ANORO ELLIPTA.

    What allergy medicine can i take with afib

    See «What are the ingredients in ANORO ELLIPTA?» under for a finish list of ingredients.

  2. have a severe allergy to milk proteins. Enquire your healthcare provider if you are not sure.
  3. have asthma.

Before using ANORO ELLIPTA, tell your healthcare provider about every of your medical conditions, including if you:

  1. have eye problems such as glaucoma. ANORO ELLIPTA may make your glaucoma worse.
  2. have liver problems.
  3. have diabetes.
  4. have high blood pressure.
  5. have prostate or bladder problems, or problems passing urine. ANORO ELLIPTA may make these problems worse.
  6. have seizures.
  7. have thyroid problems.
  8. are allergic to milk proteins.
  9. are pregnant or plan to become pregnant.

    It is not known if ANORO ELLIPTA may harm your unborn baby.

  10. have heart problems.
  11. are breastfeeding or plan to breastfeed. It is not known if the medicines, umeclidinium and vilanterol, in ANORO ELLIPTA pass into your breast milk and if they can harm your baby.

Tell your healthcare provider about every the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

ANORO ELLIPTA and certain other medicines may interact with each other. This may cause serious side effects.

Especially tell your healthcare provider if you take:

  1. atropine
  2. anticholinergics (including tiotropium, ipratropium, aclidinium)
  3. antifungal or anti-HIV medicines

Know the medicines you take. Hold a list of them to show your healthcare provider and pharmacist when you get a new medicine.

How does this medication work? What will it do for me?

Montelukast belongs to a group of medications known as leukotriene receptor antagonists. It is used to prevent and manage asthma symptoms and to relieve the symptoms of seasonal allergies, also known as seasonal allergic rhinitis or hay fever.

It works by blocking the effects of leukotrienes, a substance produced by the body in response to certain "triggers" that cause narrowing and swelling of airways in the lungs. Montelukast generally starts to work within one day.

When used to prevent and manage asthma, it is significant to understand that montelukast should not be used to relieve an asthma attack once it has started. People with asthma should always own their fast-acting asthma relief medication on hand to treat an asthma attack.

Your doctor may own suggested this medication for conditions other than the ones listed in these drug information articles. As well, some forms of this medication may not be used for every of the conditions discussed here.

If you own not discussed this with your doctor or are not certain why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they own the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.


Treatment

The management of rheumatic fever is directed toward the reduction of inflammation with anti-inflammatory medications such as aspirin or corticosteroids. Individuals with positive cultures for strep throat should also be treated with antibiotics.[32]

Aspirin is the drug of choice and should be given at high doses.[37]

One should watch for side effects love gastritis and salicylate poisoning.

In children and teenagers, the use of aspirin and aspirin-containing products can be associated with Reye’s syndrome, a serious and potentially deadly condition. The risks, benefits, and alternative treatments must always be considered when istering aspirin and aspirin-containing products in children and teenagers.

What allergy medicine can i take with afib

Ibuprofen for pain and discomfort and corticosteroids for moderate to severe inflammatory reactions manifested by rheumatic fever should be considered in children and teenagers.

Infection

People with positive cultures for Streptococcus pyogenes should be treated with penicillin as endless as allergy is not present. The use of antibiotics will not alter cardiac involvement in the development of rheumatic fever.[32] Some propose the use of benzathine benzylpenicillin.

Monthly injections of long-acting penicillin must be given for a period of five years in patients having one attack of rheumatic fever.

If there is evidence of carditis, the length of therapy may be up to 40 years. Another significant cornerstone in treating rheumatic fever includes the continual use of low-dose antibiotics (such as penicillin, sulfadiazine, or erythromycin) to prevent recurrence.

Inflammation

While corticosteroids are often used, evidence to support this is poor.[1]Salicylates are useful for pain.

Steroids are reserved for cases where there is evidence of an involvement of the heart.

The use of steroids may prevent further scarring of tissue and may prevent the development of sequelae such as mitral stenosis.

Vaccine

No vaccines are currently available to protect against S. pyogenes infection, although research is underway to develop one.[38] Difficulties in developing a vaccine include the wide variety of strains of S. pyogenes present in the environment and the large quantity of time and people that will be needed for appropriate trials for safety and efficacy of the vaccine.[39]

Heart failure

Some patients develop significant carditis which manifests as congestive heart failure.

This requires the usual treatment for heart failure: ACE inhibitors, diuretics, beta blockers, and digoxin. Unlike typical heart failure, rheumatic heart failure responds well to corticosteroids.


Diagnosis

Modified Jones criteria were first published in 1944 by T. Duckett Jones, MD.[25] They own been periodically revised by the American Heart Association in collaboration with other groups.[26] According to revised Jones criteria, the diagnosis of rheumatic fever can be made when two of the major criteria, or one major criterion plus two minor criteria, are present along with evidence of streptococcal infection: elevated or rising antistreptolysin O titre or DNAase.[8] Exceptions are chorea and indolent carditis, each of which by itself can indicate rheumatic fever.[27][28][29] An April 2013 review article in the Indian Journal of Medical Research stated that echocardiographic and Doppler (E & D) studies, despite some reservations about their utility, own identified a massive burden of rheumatic heart disease, which suggests the inadequacy of the 1992 Jones’ criteria.

What allergy medicine can i take with afib

E & D studies own identified subclinical carditis in patients with rheumatic fever, as well as in follow-ups of rheumatic heart disease patients who initially presented as having isolated cases of Sydenham’s chorea.[30] Signs of a preceding streptococcal infection include: recent scarlet fever, raised antistreptolysin O or other streptococcal antibody titre, or positive throat culture.[31]

Major criteria

  1. Polyarthritis:[32] A temporary migrating inflammation of the large joints, generally starting in the legs and migrating upwards.
  2. Carditis: Inflammation of the heart muscle (myocarditis) which can manifest as congestive heart failure with shortness of breath, pericarditis with a rub, or a new heart murmur.
  3. Erythema marginatum: A long-lasting reddish rash that begins on the trunk or arms as macules, which spread outward and clear in the middle to form rings, which continue to spread and coalesce with other rings, ultimately taking on a snake-like appearance.

    This rash typically spares the face and is made worse with heat.

  4. Subcutaneous nodules: Painless, firm collections of collagen fibers over bones or tendons. They commonly appear on the back of the wrist, the exterior elbow, and the front of the knees.
  5. Sydenham’s chorea (St. Vitus’ dance): A characteristic series of involuntary rapid movements of the face and arms. This can happen extremely tardy in the disease for at least three months from onset of infection.

Minor criteria


Pathophysiology

Rheumatic fever is a systemic disease affecting the connective tissue around arterioles, and can happen after an untreated strep throat infection, specifically due to group A streptococcus (GAS), Streptococcus pyogenes.

It is believed to be caused by antibodycross-reactivity. This cross-reactivity is a type II hypersensitivity reaction and is termed molecular mimicry. Generally, self reactive B cells remain anergic in the periphery without T cell co-stimulation. During a streptococcal infection, mature antigen-presenting cells such as B cells present the bacterial antigen to CD4+T cells which differentiate into helper T2 cells. Helper T2 cells subsequently activate the B cells to become plasma cells and induce the production of antibodies against the cell wall of Streptococcus. However the antibodies may also react against the myocardium and joints,[12] producing the symptoms of rheumatic fever.

S. pyogenes is a species of aerobic, cocci, gram-positive bacteria that are non-motile, non-spore forming, and forms chains and large colonies.[13]

S. pyogenes has a cell wall composed of branched polymers which sometimes contain M protein, a virulence factor that is highly antigenic. The antibodies which the immune system generates against the M protein may cross-react with heart muscle cell protein myosin,[14] heart muscle glycogen and smooth muscle cells of arteries, inducing cytokine release and tissue destruction. However, the only proven cross-reaction is with perivascular connective tissue.[citation needed] This inflammation occurs through direct attachment of complement and Fc receptor-mediated recruitment of neutrophils and macrophages.

Characteristic Aschoff bodies, composed of swollen eosinophiliccollagen surrounded by lymphocytes and macrophages can be seen on light microscopy. The larger macrophages may become Anitschkow cells or Aschoff giant cells. Rheumatic valvular lesions may also involve a cell-mediated immunity reaction as these lesions predominantly contain T-helper cells and macrophages.[15]

In rheumatic fever, these lesions can be found in any layer of the heart causing diverse types of carditis. The inflammation may cause a serofibrinous pericardial exudate described as «bread-and-butter» pericarditis, which generally resolves without sequelae. Involvement of the endocardium typically results in fibrinoid necrosis and wart formation along the lines of closure of the left-sided heart valves.

Warty projections arise from the deposition, while subendocardial lesions may induce irregular thickenings called MacCallum plaques.

Rheumatic heart disease

Chronic rheumatic heart disease (RHD) is characterized by repeated inflammation with fibrinous repair. The cardinal anatomic changes of the valve include leaflet thickening, commissural fusion, and shortening and thickening of the tendinous cords.[15] It is caused by an autoimmune reaction to Group A β-hemolytic streptococci (GAS) that results in valvular damage.[16] Fibrosis and scarring of valve leaflets, commissures and cusps leads to abnormalities that can result in valve stenosis or regurgitation.[17] The inflammation caused by rheumatic fever, generally during childhood, is referred to as rheumatic valvulitis.

About half of patients with rheumatic fever develop inflammation involving valvular endothelium.[18] The majority of morbidity and mortality associated with rheumatic fever is caused by its destructive effects on cardiac valve tissue.[17] The pathogenesis of RHD is complicated and not fully understood, but it is known to involve molecular mimicry and genetic predisposition that lead to autoimmune reactions.

Molecular mimicry occurs when epitopes are shared between host antigens and Streptococcus antigens.[19] This causes an autoimmune reaction against native tissues in the heart that are incorrectly recognized as «foreign» due to the cross-reactivity of antibodies generated as a result of epitope sharing.

The valvular endothelium is a prominent site of lymphocyte-induced damage. CD4+ T cells are the major effectors of heart tissue autoimmune reactions in RHD.[20] Normally, T cell activation is triggered by the presentation of bacterial antigens. In RHD, molecular mimicry results in incorrect T cell activation, and these T lymphocytes can go on to activate B cells, which will start to produce self-antigen-specific antibodies. This leads to an immune response attack mounted against tissues in the heart that own been misidentified as pathogens. Rheumatic valves display increased expression of VCAM-1, a protein that mediates the adhesion of lymphocytes.[21] Self-antigen-specific antibodies generated via molecular mimicry between human proteins and streptococcal antigens up-regulate VCAM-1 after binding to the valvular endothelium.

This leads to the inflammation and valve scarring observed in rheumatic valvulitis, mainly due to CD4+ T cell infiltration.[21]

While the mechanisms of genetic predisposition remain unclear, a few genetic factors own been found to increase susceptibility to autoimmune reactions in RHD. The dominant contributors are a component of MHC class II molecules, found on lymphocytes and antigen-presenting cells, specifically the DR and DQ alleles on human chromosome 6.[22] Certain allele combinations appear to increase RHD autoimmune susceptibility.

Human leukocyte antigen (HLA) class II allele DR7 (HLA-DR7) is most often associated with RHD, and its combination with certain DQ alleles is seemingly associated with the development of valvular lesions.[22] The mechanism by which MHC class II molecules increase a host’s susceptibility to autoimmune reactions in RHD is unknown, but it is likely related to the role HLA molecules frolic in presenting antigens to T cell receptors, thus triggering an immune response.

Also found on human chromosome 6 is the cytokine TNF-α which is also associated with RHD.[22] High expression levels of TNF-α may exacerbate valvular tissue inflammation, contributing to RHD pathogenesis. Mannose-binding lectin (MBL) is an inflammatory protein involved in pathogen recognition. Diverse variants of MBL2 gene regions are associated in RHD. RHD-induced mitral valve stenosis has been associated with MBL2 alleles encoding for high production of MBL.[23] Aortic valve regurgitation in RHD patients has been associated with diverse MBL2 alleles that encode for low production of MBL.[24] Other genes are also being investigated to better understand the complexity of autoimmune reactions that happen in RHD.


Signs and symptoms

The disease typically develops two to four weeks after a throat infection.[2] Symptoms include: fever, painful joints with those joints affected changing with time, involuntary muscle movements, and occasionally a characteristic non-itchy rash known as erythema marginatum. The heart is involved in about half of the cases. Damage to the heart valves generally occurs only after multiple attacks but may occasionally happen after a single case of RF. The damaged valves may result in heart failure and also increase the risk of atrial fibrillation and infection of the valves.[1]


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