Overview
Rheumatic chorea, often associated with Sydenham's chorea, is a neurological manifestation of rheumatic fever characterized by involuntary movements. This condition can sometimes overlap with the PANDAS subgroup, which involves neuropsychiatric symptoms linked to streptococcal infections, though cardiac involvement in PANDAS remains unclear 1.Diagnosis
Key Criteria: Presence of frank chorea, exclusion of other neurologic disorders, history of preceding group A beta-hemolytic streptococcal infection.
Recommended Tests: Doppler and 2-dimensional echocardiograms to assess valvular heart disease.
Grading: No significant mitral or aortic valve regurgitation typically observed; mild mitral regurgitation noted in rare cases 1.Management
First-Line Treatments: Anti-inflammatory agents such as salicylates or corticosteroids to manage chorea symptoms.
Adjunctive Treatments: Antibiotics to eradicate streptococcal infection, psychological support for neuropsychiatric symptoms.
Specific Drug Classes: Dosage specifics not detailed in provided abstracts.Special Populations
Pediatrics: Two-thirds of children with Sydenham's chorea also exhibit rheumatic carditis, often with mitral valve involvement 1.
Cardiac Involvement in PANDAS: No significant cardiac involvement detected in a study of 60 PANDAS patients, with only one case of mild mitral regurgitation 1.Key Recommendations
Perform echocardiograms to rule out significant valvular heart disease in patients diagnosed with PANDAS to differentiate from Sydenham's chorea (Evidence: Moderate) 1.
Initiate anti-inflammatory therapy for chorea symptoms in rheumatic chorea, tailored to clinical severity (Evidence: Expert opinion).
Consider psychological interventions alongside medical management for neuropsychiatric symptoms in PANDAS patients (Evidence: Expert opinion).References
1 Snider LA, Sachdev V, MaCkaronis JE, St Peter M, Swedo SE. Echocardiographic findings in the PANDAS subgroup. Pediatrics 2004. link