An Overview of Rheumatic Fever

A complication of strep throat

Boy being examined by a doctor for a sore throat.

ADAM GAULT / SPL / Getty Images

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Rheumatic fever is an inflammatory disease that develops when streptococcal A infections, such as strep throat, scarlet fever, and cellulitis, aren't properly treated. Streptococcus bacteria are believed to trick your immune system into attacking healthy tissues in your body, the result of which is rampant inflammation that causes numerous symptoms.

Rheumatic fever most often affects children, typically between ages 5 and 15, since strep infections are most common in this age group. While rare in the United States, it is a serious condition worth knowing more about.

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
  • Ring- or snake-like rash on the torso, arms, and legs
  • 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 (bouts of unusual laughing or crying)

Symptoms of rheumatic fever usually come on between two and four weeks after the initial illness.

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)
  • Heart failure

Sydenham chorea may also be considered a complication of rheumatic fever, even though it's also one of the symptoms. Its symptoms are signs of neurological damage, which is typically not permanent.

Causes

Rheumatic fever typically occurs when a streptococcal infection goes untreated, which allows bacteria to proliferate and trigger significant inflammation. While those with compromised immune systems are at greater risk, anyone can develop rheumatic fever.

Rheumatic fever itself is not contagious, as it is a complication of an infection rather than an illness onto itself. The streptococcal infections that cause rheumatic fever, however, are quite transmissable. They primarily spread through respiratory droplets that are sneezed or coughed up by the sick person.

Rheumatic fever is more common in parts of the developing world. In the U.S., it's most common in people who live in poverty and have limited access to proper medical care, but is still considered rare overall.

Diagnosis

Rheumatic fever can't be diagnosed by a simple blood test. If a doctor suspects you or your child have it, they'll make a diagnosis based on multiple tests and diagnostic criteria.

Typically, the diagnosis comes after a recent strep infection when symptoms meet either:

  • Two of the major criteria
    OR
  • One major and two minor criteria

Major Criteria

  • Pain (arthritis) in several joints

  • Heart inflammation (carditis) as determined by echocardiogram

  • Nodules under the skin

  • Quick, jerky movements

  • Rash

Minor Criteria

Tests your doctor may order include:

  • Throat culture or blood test to confirm the presence of strep
  • Blood tests to rule out other illnesses that can cause similar symptoms
  • Possibly a chest X-ray, electrocardiogram, or echocardiogram to see if your heart has been affected

Treatment

Rheumatic fever has to be treated with antibiotics. The first round is intended to get rid of the current infection. Anti-inflammatory medications (such as aspirin, ibuprofen, and corticosteroids) may also be used to help manage symptoms.

Once the current infection is cleared up, you'll take long-term antibiotics at low doses to prevent the disease from recurring, probably for at least five years.

Children typically continue this until they're 21, but if they have heart problems from the illness, they may stay on the medication for life.

A Word From Verywell

The easiest way to prevent rheumatic fever is to:

  • Recognize a strep infection early
  • Get proper treatment
  • Take all of your antibiotics as directed
  • Call your doctor if the illness doesn't go away, worsens, or if symptoms come back

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

  2. Cleveland Clinic. Rheumatic fever. Updated September 15, 2017.

  3. MedlinePlus. Rheumatic Fever. Updated February 4, 2020.

  4. Centers for Disease Control and Prevention. Rheumatic Fever: All You Need to Know. Updated November 1, 2018.