The incidence of acute rheumatic fever has increased in the developed world. Although the criteria for diagnosis are well known, the clinical symptoms needed to make a diagnosis do not always arise concurrently and the initial illness may be mild and short lived. Isolated arthritis is the presenting symptom in 14-42% of patients. There may be no history of sore throat, or this symptom may not be mentioned by the patient, and the carditis may be silent The diagnosis will be missed if appropriate investigations are not carried out during the acute illness. These patients are susceptible to recurrent attacks of rheumatic fever, and damage to heart valves becomes increasingly severe with each subsequent attack. Children are affected more than adults and may present to their general practitioners or to accident and emergency, orthopaedic, rheumatology, or paediatric departments. To highlight potential diagnostic problems, we describe three cases of rheumatic fever in young people who presented to one musculoskeletal centre in a six month period.
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