Clinical features of first attack of rheumatic fever in adults.

The clinical features of the first attack acute rheumatic fever in 32 adults are described in a prospective study. Classical migratory polyarthritis occurred in 11 patients whilst the arthritis in the remaining 21 was additive in type, rapidly becoming symmetrical. The lower limb joints were involved more frequently than those of the upper limb. Mild transient carditis was present in only one patient. All patients showed evidence of antecedent streptococcal infection but none had chorea, subcutaneous nodules or erythema marginatum. The disease ran a benign course so that the sensitivity of the modified Jones criteria for adult rheumatic fever needs re-evaluation. Rheumatic fever is still a significant health problem in Iraq and should always be considered in the differential diagnosis of acute polyarthritis in adults.