Rheumatic Fever Diagnosis and Complications

Boy being examined by a doctor for a sore throat.

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In This Article

Rheumatic fever is a serious complication that can occur after an infection with the streptococcus bacteria. Streptococcus causes infections such as strep throat, scarlet fever, and cellulitis.

If these infections are not properly treated, they can lead to rheumatic fever, which can damage the heart, joints, skin, and brain. It most often affects children typically between ages 5 and 15, since strep infections are most common in this age group.

Symptoms 

Symptoms of rheumatic fever may include:

  • Fever
  • Stomach pain
  • Joint pain (arthritis)—primarily in the knees, elbows, ankles, and wrists.
  • Joint swelling
  • Skin nodules
  • Nosebleeds
  • Rash on torso, arms, and legs that looks ring or snake-like
  • Heart problems—could result in shortness of breath or chest pain, but may not have symptoms at all.
  • Sydenham chorea—muscle weakness, jerky movements of the face, feet, and hands, difficulty with emotions.

Causes

Rheumatic fever occurs about one to five weeks after a strep infection. It is rare in the United States, but is common in other parts of the developing world. It typically occurs when a strep infection goes untreated.

Diagnosis

There is no simple blood test to diagnose rheumatic fever. If a doctor suspects that a person has rheumatic fever, a diagnosis would be based on multiple tests and diagnostic criteria. Typically, a person will be diagnosed if they have had a recent strep infection and meet two of the major criteria or one major and two minor criteria. These include:

Major

  • Pain (arthritis) in several joints
  • Heart inflammation (carditis)—determined by using an echocardiogram
  • Nodules under the skin
  • Quick jerky movements
  • Rash

Minor

Treatment

Rheumatic fever has to be treated with antibiotics. After the initial treatment, many people have to take low doses of antibiotics for many years to prevent the disease from recurring. Anti-inflammatory medications (such as aspirin, ibuprofen, and corticosteroids) may also be used to help manage the symptoms.

Complications

Serious heart damage can occur from rheumatic fever. This may include abnormal heart rhythms (arrhythmias), damage to the heart valves (mitral stenosis or aortic stenosis), inflammation of the heart tissues (endocarditis or pericarditis) and heart failure.

Sydenham chorea may also be considered a complication of rheumatic fever, although it is also one of the symptoms. It consists of changes in emotions, fast jerky movements of the hands, feet, and face and muscle weakness. All of these are signs of neurological damage, however, the damage is typically not permanent.

A Word From Verywell

The easiest way to prevent rheumatic fever is to treat any strep infection completely. If you or your child are diagnosed with strep throat, scarlet fever or cellulitis, make sure you take all of your antibiotics as directed. Contact your healthcare provider right away if you have signs of or are concerned about rheumatic fever.

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Article Sources

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  1. Cleveland Clinic. Rheumatic fever. September 15, 2017.

Additional Reading

  • Centers for Disease Control and Prevention. Group A Streptococcal (GAS) Disease. Rheumatic fever. November 1, 2018.

  • MedlinePlus. Rheumatic fever. October 2, 2019.