Acute rheumatic fever during childhood in Kuwait: the mild nature of the initial attack

A prospective clinical study is reported of the initial attack of acute rheumatic fever in 210 children seen in Kuwait over a period of four years. The main presenting feature was pain in the joints, caused by arthritis in 79% of our patients and by arthralgia in 15%. Five per cent presented with chorea alone and 1% with congestive heart failure alone. Carditis was detected in 46.2%, cardiomegaly in 10%, pericarditis in 1.4% and congestive heart failure in 4.8%. The incidence of chorea was 7.6%, of erythema marginatum 1% and of subcutaneous nodules 0.5%. The mortality rate was 0.5%. Data from this study reflect the mild nature of acute rheumatic fever in Kuwait, in contrast to the aggressive nature of the disease described from neighbouring and developing countries.