Understanding Rheumatic Fever

Rheumatic fever is a disease that affects the joints, heart, and central nervous system. It's caused by inflammation in the body from a strep infection. It's most common in children ages 5 to 15. Since the development of antibiotics, the cases have significantly declined in the U.S. compared to less developed countries.

What causes rheumatic fever?

Rheumatic fever can develop after a strep throat or another strep infection. If the strep infection goes untreated or undertreated, inflammation can attack the heart, joints, and the nervous system.

Certain things may raise the risk for rheumatic fever. Genes may play a part. So may the environment. The disease tends to happen more often in places where there is overcrowding or a lack of medical care. Rheumatic fever also occurs in people who have strep throat but don’t know they have it because they don’t have any symptoms.

What are the symptoms of rheumatic fever?

It usually takes about 1 to 5 weeks after a strep infection for rheumatic fever to develop.

Some symptoms can be severe, such as those that affect the heart. Symptoms may include:

• Short-term arthritis that moves from joint to joint, such as the knees and wrists.

• Inflammation of the heart and heart valve. This may cause problems like a heart murmur or chest pain (rheumatic heart disease).

• Sydenham chorea. This nervous system disorder results in uncontrolled movements and muscle weakness. It can also result in behavioral changes.

• Bumps under the skin. These are often near the elbow, knees, or ankles.

• Ring-shaped pink rash. This occurs on the upper arms and torso.

• Fever.

• Stomachache.

• Rash.

How is rheumatic fever diagnosed?

To diagnose rheumatic fever, doctors look for specific symptoms. For example, they look for fever, joint inflammation, rash or nodules under the skin, abnormal heart rhythms or murmurs, and signs of nerve inflammation. Also, you may have a throat culture, blood tests, electrocardiogram, and echocardiogram.

How is rheumatic fever treated?

The main concern for rheumatic fever is its effect on the heart. Treatment is aimed at stopping the inflammation that is leading to serious heart problems. Treatment also eases other symptoms. Treatments include:

• Rest. Plenty of rest can help reduce joint pain. It may also limit heart damage.

• Antibiotics. Antibiotics are given to kill any lasting strep bacteria in the body.

• Anti-inflammatory medicine. Aspirin can reduce fever and inflammation. You may need a steroid for severe symptoms.

People who have an episode of rheumatic fever may need to take antibiotics for several years. This is to prevent another episode of strep throat.

What are the complications of rheumatic fever?

Complications may include:

• Heart disease with leaking heart valves or an enlarged heart.

• Heart failure.

Permanent heart damage may show up years after the first episode of rheumatic fever. So long-term follow-up care is needed. If a child has rheumatic fever, the information should always be included in the permanent health history, even into adulthood. This is because the person will need regular heart exams for the rest of their life.

When should you contact your doctor?

Contact your doctor right away if any of the following occur:

• Fever of 100.4°F (38°C) or higher, or as directed by your doctor

• Pain that gets worse

• Symptoms that don’t get better, or get worse

• New symptoms