• chorea
• rheumatic fever
• Sydenham's chorea

The aim of the study is to evaluate the presence of psychiatric conditions in patients with a previous diagnosis of rheumatic fever, with or without Sydenham’s chorea, several years after its clinical onset.
Even though the clinical association between Sydenham’s chorea and neuropsychiatric disorders has already been studied, nature and timing of the latter still need to be clarified: neuropsychiatric symptoms are mainly reported in the acute phase of the disease, but there are numerous literature studies where they are showed to precede or follow the acute disease onset, even by years. Nevertheless, an extensive characterization of these symptoms is still lacking.
To investigate this topic, we enrolled 48 patients with a previous diagnosis of rheumatic fever from 7 different centers located all over Italy. The overall population was divided in two groups: a group (SC) formed by those patients who had Sydenham’s chorea (n=21) and another group (nSC) consisting of patients with a history of rheumatic fever without Sydenham’s chorea. 7 different psychiatric questionnaires were administered to all participants to evaluate their work and social functioning and to assess the presence of mood disorders, anxiety disorders, psychotic disorders, personality disorders, PTSD, and other psychiatric disorders.
Demographic variables, clinical data and information about diagnostic process, therapy and follow-up were also collected and compared between our two groups of patients.
The data collected suggest a general higher frequency of psychiatric conditions among patients with a previous diagnosis of Sydenham’s chorea when compared with those who were diagnosed with rheumatic fever in absence of choreic symptoms, revealing that Sydenham’s chorea can exert a strong psychopathological impact on patients even years after the acute onset of symptoms. In particular, the administration of the Work and Social Adjustment Scale (WSAS) showed a significantly higher amount of work and social functioning difficulties in the SC group (mean=2.48, S.D.=0.512, mean rank=28.69) than in the nSC group (mean=2.19, S.D.=0.483, mean rank=21.24). Furthermore, 60,4% (n=29) of the overall population experienced neuropsychiatric symptoms other than choreic movements at diagnosis and this finding was significantly more common (p=0.00) in SC patients (95.2%) than in nSC patients (33.3%). The analysis of the data deriving by the other questionnaires also produced results indicating a higher psychopatological involvement for patients with a history of Sydenham’s chorea when compared to the nSC group, but further research involving more numerous populations of patients will be needed to reach statistical significance.