Definition

What is rheumatic fever?

Rheumatic fever is an inflammatory disease that can develop as a complication of inadequately treated strep throat or scarlet fever. Strep throat and scarlet fever are caused by an infection with streptococcus bacteria.

Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure. Treatments can reduce damage from inflammation, lessen pain and other symptoms, and prevent the recurrence of rheumatic fever.

How common is rheumatic fever?

Rheumatic fever is most common in 5- to 15-year-old children, though it can develop in younger children and adults. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of rheumatic fever?

The common symptoms of rheumatic fever are:

  • Fever
  • Painful and tender joints — most often in the knees, ankles, elbows and wrists
  • Pain in one joint that migrates to another joint
  • Red, hot or swollen joints
  • Small, painless bumps (nodules) beneath the skin
  • Chest pain
  • Heart murmur
  • Fatigue
  • Flat or slightly raised, painless rash with a ragged edge (erythema marginatum)
  • Jerky, uncontrollable body movements (Sydenham chorea, or St. Vitus’ dance) — most often in the hands, feet and face
  • Outbursts of unusual behavior, such as crying or inappropriate laughing, that accompanies Sydenham chorea

Rheumatic fever symptoms vary. You can have few symptoms or several, and symptoms can change during the course of the disease. The onset of rheumatic fever usually occurs about two to four weeks after a strep throat infection.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes rheumatic fever?

Rheumatic fever can occur after an infection of the throat with a bacterium called group A streptococcus. Group A streptococcus infections of the throat cause strep throat or, less commonly, scarlet fever. Group A streptococcus infections of the skin or other parts of the body rarely trigger rheumatic fever.

The link between strep infection and rheumatic fever isn’t clear, but it appears that the bacterium tricks the immune system. The strep bacterium contains a protein similar to one found in certain tissues of the body. So immune system cells that would normally target the bacterium may treat the body’s own tissues as if they were infectious agents — particularly tissues of the heart, joints, skin and central nervous system. This immune system reaction results in inflammation.

If your child receives prompt treatment with an antibiotic to eliminate strep bacteria and takes all medication as prescribed, there’s little chance of developing rheumatic fever. If your child has one or more episodes of strep throat or scarlet fever that aren’t treated or not treated completely, he or she might develop rheumatic fever.

Risk factors

What increases my risk for rheumatic fever?

There are many risk factors for rheumatic fever, such as:

  • Family history. Some people carry a gene or genes that might make them more likely to develop rheumatic fever.
  • Type of strep bacteria. Certain strains of strep bacteria are more likely to contribute to rheumatic fever than are other strains.
  • Environmental factors. A greater risk of rheumatic fever is associated with overcrowding, poor sanitation and other conditions that can easily result in the rapid transmission or multiple exposures to strep bacteria.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is rheumatic fever diagnosed?

Although there’s no single test for rheumatic fever, diagnosis is based on medical history, physical exam and certain test results.

  • Blood tests: If your child was already diagnosed with a strep infection, your doctor might not order additional tests for the bacterium. If your doctor orders a test, it will most likely be a blood test that can detect antibodies to the strep bacterium circulating in the blood. The actual bacterium might no longer be detectable in your child’s throat tissues or blood. Your doctor also is likely to check for inflammation in your child’s blood by measuring C-reactive protein and the erythrocyte sedimentation rate.
  • Electrocardiogram (ECG or EKG): This test — also called an ECG or EKG — records electrical signals as they travel through your child’s heart. Your doctor can look for patterns among these signals that indicate inflammation of the heart or poor heart function.
  • Echocardiogram: Using sound waves to produce live-action images of the heart, this test can enable your doctor to detect heart abnormalities.

How is rheumatic fever treated?

The goals of treatment for rheumatic fever are to destroy remaining group A streptococcal bacteria, relieve symptoms, control inflammation and prevent recurrences.

Treatments include:

  • Your child’s doctor will prescribe penicillin or another antibiotic to eliminate remaining strep bacteria. After your child has completed the full antibiotic treatment, your doctor will begin another course of antibiotics to prevent recurrence of rheumatic fever. Preventive treatment will likely continue through age 21 or until your child completes a minimum five-year course of treatment, whichever is longer. People who have had heart inflammation during rheumatic fever might be advised to take the preventive antibiotic treatment for 10 years or longer.
  • Anti-inflammatory treatment. Your doctor will prescribe a pain reliever, such as aspirin or naproxen (Naprosyn), to reduce inflammation, fever and pain. If symptoms are severe or your child isn’t responding to the anti-inflammatory drugs, your doctor might prescribe a corticosteroid.
  • Anticonvulsant medications. For severe involuntary movements caused by Sydenham chorea, your doctor might prescribe an anticonvulsant, such as valproic acid (Depakene) or carbamazepine (Carbatrol, Tegretol, others).

Discuss with your doctor what type of follow-up and long-term care your child will need. Heart damage from rheumatic fever might not show up for years. When your child grows up, he or she needs to include the information in his or her medical history and get regular heart exams.

Lifestyle changes & Home remedies

What are some lifestyle changes or home remedies that can help me manage rheumatic fever?

The following lifestyles and home remedies might help you cope with rheumatic fever:

Your doctor might recommend bed rest for your child and ask you to restrict his or her activities until inflammation, pain and other symptoms have improved. If inflammation is in heart tissues, your child might need strict bed rest for a few weeks to a few months, depending on the degree of inflammation.

The only way to prevent rheumatic fever is to treat strep throat infections or scarlet fever promptly with a full course of appropriate antibiotics.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: July 11, 2017 | Last Modified: July 11, 2017

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