Acute Rheumatic Fever in Adult
Main Article Content
This research aims to review and synthesize current evidence regarding the epidemiology, pathophysiology, clinical manifestations, diagnostic challenges, and management strategies of acute rheumatic fever (ARF) in adult populations. The research employed a narrative literature review method by analyzing peer-reviewed articles, clinical guidelines, and authoritative reports obtained from PubMed, Google Scholar, Scopus-indexed journals, WHO, and CDC publications published between 2015 and 2025. The findings indicate that ARF in adults presents distinct clinical characteristics compared to pediatric cases, with migratory polyarthritis being the most dominant manifestation and carditis frequently occurring in a subclinical form, leading to delayed diagnosis. The application of the revised 2015 Jones criteria has improved diagnostic accuracy, particularly in endemic regions; however, challenges remain in differentiating ARF from other inflammatory joint diseases and in maintaining adherence to long-term secondary prophylaxis. The discussion highlights that socioeconomic factors, limited healthcare access, and low compliance with benzathine penicillin G prophylaxis significantly contribute to the high burden of rheumatic heart disease in adults, especially in Indonesia. In conclusion, acute rheumatic fever in adults remains a clinically significant condition requiring heightened diagnostic awareness, consistent secondary prevention, and integrated public health strategies to prevent disease progression and reduce long-term cardiovascular complications.
Ambari, A. M. (2023). Management of Rheumatic Heart Disease in Low-to-Middle-Income Country. Utrecht University.
Ardani, N. I. T., & Aditya, G. (2024). Rheumatic Heart Disease in East of Bali Indonesia. Bioscientia Medicina: Journal of Biomedicine and Translational Research, 8(8), 4705–4711.
Balan, S., Krishna, M. P., Sasidharan, A., & Mithun, C. B. (2025). Acute rheumatic fever and Post-streptococcal reactive arthritis. Best Practice & Research Clinical Rheumatology, 39(2), 102067.
Chioncel, O., Parissis, J., Mebazaa, A., Thiele, H., Desch, S., Bauersachs, J., Harjola, V.-P., Antohi, E.-L., Arrigo, M., & Ben Gal, T. (2020). Epidemiology, pathophysiology and contemporary management of cardiogenic shock–a position statement from the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 22(8), 1315–1341.
Elendu, C., Amaechi, D. C., Elendu, T. C., Fiemotonghan, B., Okoye, O. K., Agu-Ben, C. M., Onyekweli, S. O., Amapu, D. A., Ikpegbu, R., & Asekhauno, M. (2024). A comprehensive review of heart failure: Unraveling the etiology, decoding pathophysiological mechanisms, navigating diagnostic modalities, exploring pharmacological interventions, advocating lifestyle modifications, and charting the horizon of emerging therapies in the complex landscape of chronic cardiac dysfunction. Medicine, 103(3), e36895.
Hasan, F., Dey, M., & Nune, A. (2025). Acute Rheumatic Fever in Caucasians: A Case Report and Systematic Review. Life, 15(7), 1131.
Hu, H., & Liu, X. (2025). The Persisting Burden of Rheumatic Heart Disease: Insights From the Ina-RHD Study. In JACC: Asia (Vol. 5, Issue 9, pp. 1184–1186). American College of Cardiology Foundation Washington DC.
Irene, J., & Olfriani, C. (2024). Advancing Rheumatic Heart Disease Management in Indonesia: Strengthening Early Detection, Targeted Screening, and Prevention Strategies. The International Journal of Medical Science and Health Research, 6(3), 22–45.
Moon, J. Y., El Labban, M., Gajic, O., & Odeyemi, Y. (2025). Strategies for preventing and reducing the impact of acute respiratory failure from pneumonia. Expert Review of Respiratory Medicine, 19(3), 205–221.
Organization, W. H. (2024). WHO guideline on the prevention and diagnosis of rheumatic fever and rheumatic heart disease. World Health Organization.
Pabolu, S., Dudekula, A., & Pitchumoni, C. S. (2021). Gastrointestinal manifestations of non-GI disorders. In Geriatric gastroenterology (pp. 2117–2166). Springer.
Rémond, M. G. W., Coyle, M. E., Mills, J. E., & Maguire, G. P. (2016). Approaches to improving adherence to secondary prophylaxis for rheumatic fever and rheumatic heart disease: a literature review with a global perspective. Cardiology in Review, 24(2), 94–98.
Sapna, F. N. U., Raveena, F. N. U., Chandio, M., Bai, K., Sayyar, M., Varrassi, G., Khatri, M., Kumar, S., & Mohamad, T. (2023). Advancements in heart failure management: a comprehensive narrative review of emerging therapies. Cureus, 15(10).
Sarin, S. K., Choudhury, A., Kumar, A., Mahmud, N., Lee, G. H., Ning, Q., Tan, S.-S., Thanapirom, K., Arora, V., & Nakayama, N. (2026). Acute-on-chronic liver failure: pathophysiological mechanisms and clinical management. Nature Reviews Gastroenterology & Hepatology, 1–21.
Siam, N. H., Snigdha, N. N., Tabasumma, N., & Parvin, I. (2024). Diabetes mellitus and cardiovascular disease: exploring epidemiology, pathophysiology, and treatment strategies. Reviews in Cardiovascular Medicine, 25(12), 436.
Soesanto, A. M., Almazini, P., Ariani, R., Rudiktyo, E., Ardini, T. W., Mumpuni, H., Lefi, A., Ghaznawie, A. F., Sari, N. M. A. W., & Yanni, M. (2025). Characteristics and problems of rheumatic heart disease in Indonesia: the Ina-RHD multicenter study. JACC: Asia, 5(9), 1171–1183.
Soesanto, A. M., & Suastika, L. O. S. (2020). Echocardiography screening for latent rheumatic heart disease: what can we do in Indonesia? Frontiers in Surgery, 7, 46.
Steer, A., & Gibofsky, A. (2021). Acute rheumatic fever: epidemiology and pathogenesis. Uptodate. Waltham, MA: Uptodate.
Watkins, D. A., Beaton, A. Z., Carapetis, J. R., Karthikeyan, G., Mayosi, B. M., Wyber, R., Yacoub, M. H., & Zühlke, L. J. (2018). Rheumatic heart disease worldwide: JACC scientific expert panel. Journal of the American College of Cardiology, 72(12), 1397–1416.
