Contemporary Clinical Characteristics and Presentation of ARF Globally

Background: Acute rheumatic fever (ARF) is a significant public health concern in resource-limited settings, but its clinical presentation remains inadequately described.This study leverages data from the ARF Diagnostic (ARC) Network to provide a global overview of ARF characteristics.Methods: Children aged 3-18 years from Brazil, Malawi, Pakistan, and Timor-Leste were enrolled based on clinical signs of joint pain, suspected rheumatic carditis, chorea, or known rheumatic heart disease (RHD) with suspected ARF recurrence.A standardized enrollment protocol was used across all sites.Results: A total of 202 children with definite ARF were included: Brazil (n = 17), Malawi (n = 36), Pakistan (n = 129), and Timor-Leste (n = 20).Most cases (93%) occurred within the 5-14-year-old-age group, with site-specific median ages ranging from 8 to 11 years.Males comprised 57% of the cohort.First-episode ARF accounted for 74% of cases, while 26% were recurrent episodes.The breakdown of major manifestations among these cases included 72% with joint symptoms (5.5% polyarthritis, 90% polyarthralgia, 4% monoarthritis), 82% with carditis (77% moderate/severe, 23% mild), 2.5% with subcutaneous nodules, 0.5% with erythema marginatum, and 22% with chorea.Regional variation was notable: 47% of Brazilian patients presented with chorea, 83% had carditis in Pakistan, and joint involvement was common in Malawi (78%) and Timor-Leste (90%).Conclusions: These findings highlight regional variation in ARF manifestations and the need for improved diagnostic and management strategies in high-burden areas.It remains unclear whether differences in clinical presentation reflect variations in careseeking behavior or true disease prevalence.