Rheumatic Fever: Symptoms, Causes, Diagnosis and Treatment

Written by Medicover Team and Medically Reviewed by Dr Vamsi Krishna Kedarisetti , General Medicine

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Rheumatic fever (RF) is an autoimmune inflammatory condition that can develop when strep throat or scarlet fever caused by group A Streptococcus bacteria is not treated properly. The condition most commonly affects children between 5 and 15 years of age, although younger children and adults can also develop it.

Rheumatic fever can affect the heart, joints, skin and nervous system. Repeated or severe episodes may cause permanent heart valve damage and lead to rheumatic heart disease. Early treatment can reduce inflammation, relieve symptoms and help prevent the condition from recurring.

What Are the Types of Rheumatic Fever?

Rheumatic fever can affect different organs and tissues. The main forms are classified according to the part of the body involved.

Rheumatic Carditis: Inflammation affects the heart and may damage the heart valves, muscle or surrounding tissues.
Migratory Polyarthritis: Painful inflammation moves from one large joint to another, commonly affecting the knees, ankles, elbows and wrists.
Sydenham Chorea: The nervous system is affected, causing involuntary movements, muscle weakness and changes in behaviour.
Erythema Marginatum: A rare, painless skin rash with pink or red rings may appear on the trunk or limbs.
Subcutaneous Nodules: Small, firm and usually painless lumps may develop beneath the skin near joints or bony areas.

What Are the Symptoms of Rheumatic Fever?

Symptoms of rheumatic fever vary depending on the organs affected. A person may experience one or several symptoms, and the pattern of symptoms can change during the illness.

Fever
Chest pain
Fatigue
Shortness of breath
Heart murmur
Heart arrhythmias
Painful, red, swollen and tender joints, especially the knees, ankles, elbows and wrists
Uncontrolled jerky movements of the face, hands or feet
Small, painless bumps beneath the skin
A painless, ring-shaped skin rash

What Causes Rheumatic Fever?

Rheumatic fever develops when the immune system reacts abnormally after an infection caused by group A Streptococcus bacteria. Instead of attacking only the bacteria, the immune response can mistakenly target healthy tissues in the heart, joints, skin and nervous system.

Untreated Strep Throat

Rheumatic fever can develop after strep throat is not treated or is inadequately treated with appropriate antibiotics.

Scarlet Fever

Scarlet fever is another group A streptococcal infection that can trigger the abnormal immune response associated with rheumatic fever.

Abnormal Immune Response

The body's immune system may mistakenly attack healthy tissues after a streptococcal infection. The exact reason this reaction occurs in some people is not fully understood.

Genetic Susceptibility

Some people may have inherited factors that make them more susceptible to developing rheumatic fever after a group A streptococcal infection.

When Should You See a Doctor for Rheumatic Fever?

Medical evaluation by a General Medicine Specialist is important after a recent streptococcal infection if symptoms such as fever, joint pain, chest discomfort, or abnormal movements develop. Early diagnosis and treatment can reduce inflammation, protect the heart, and lower the risk of recurrent rheumatic fever.

You should see a doctor if you have:

A persistent sore throat, fever or painful swallowing
New joint pain or swelling after a recent throat infection
Unusual fatigue, skin changes or involuntary movements

Get medical help immediately if:

Severe chest pain or difficulty breathing develops
Fainting or a rapid or irregular heartbeat occurs
Sudden uncontrolled movements or severe weakness develop

These could be signs of a serious complication like rheumatic carditis, which needs urgent care.

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How Is Rheumatic Fever Diagnosed?

There is no single test that confirms rheumatic fever. Diagnosis is based on symptoms, physical examination, evidence of a recent group A streptococcal infection and tests that assess inflammation and possible heart involvement.

Medical History and Physical Examination

The doctor reviews recent symptoms, including sore throat, fever and joint pain, and checks for heart murmurs, joint inflammation, skin changes and abnormal movements.

Throat Swab

A throat swab may be used to detect group A Streptococcus bacteria, especially when an active throat infection is suspected.

Blood Tests

Blood tests may check for signs of inflammation and antibodies that indicate a recent streptococcal infection.

Electrocardiogram

An electrocardiogram (ECG) measures the electrical activity of the heart and can detect abnormal heart rhythms or other changes.

Echocardiogram

An echocardiogram uses sound waves to examine the heart valves and pumping function. It can detect heart inflammation and valve damage that may not cause obvious symptoms.

Chest X-Ray

A chest X-ray may be used to check for heart enlargement or fluid buildup in the lungs.

How Is Rheumatic Fever Treated?

Treatment for rheumatic fever aims to eliminate any remaining streptococcal infection, reduce inflammation, relieve symptoms and prevent future episodes. The treatment plan depends on the organs affected and the severity of the condition.

Antibiotics

Antibiotics are prescribed to eliminate group A Streptococcus bacteria. Long-term preventive antibiotics may also be recommended to reduce the risk of recurrent rheumatic fever and further heart damage.

Anti-Inflammatory Medications

Anti-inflammatory medicines may be used to reduce fever, inflammation and joint pain. The specific medicine depends on the patient's age, symptoms and overall health.

Corticosteroids

Corticosteroids may be prescribed when severe inflammation affects the heart or when other anti-inflammatory treatments are not sufficient.

Treatment for Sydenham Chorea

Medicines may be used to control severe involuntary movements and behavioural symptoms associated with Sydenham chorea.

Rest and Supportive Care

Rest may be recommended during the acute phase, especially when the heart is affected. Activity can usually be increased gradually as inflammation and symptoms improve.

Heart Surgery

Severe, permanent heart valve damage may eventually require surgical valve repair or replacement.

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What Are the Risk Factors for Rheumatic Fever?

Certain factors can increase the likelihood of developing rheumatic fever after a group A streptococcal infection.

Age: Rheumatic fever is most common in children between 5 and 15 years of age.
Previous Rheumatic Fever: A previous episode increases the risk of recurrence after another streptococcal infection.
Genetic Factors: Some people may inherit a greater susceptibility to the abnormal immune response.
Certain Strains of Strep Bacteria: Some strains of group A Streptococcus are more likely to trigger rheumatic fever.
Overcrowded Living Conditions: Close contact increases the spread of streptococcal infections.
Poor Sanitation: Limited hygiene facilities can increase exposure to infections.
Limited Access to Healthcare: Delayed diagnosis and treatment of strep throat can increase the risk.

What Are the Complications of Rheumatic Fever?

The most serious complications of rheumatic fever involve the heart. Repeated episodes can cause progressive and permanent damage to the heart valves.

Rheumatic Heart Disease: Permanent heart valve damage can develop after severe or recurrent rheumatic fever.
Mitral or Aortic Valve Damage: The valves may become narrowed or may leak, affecting normal blood flow.
Heart Muscle Damage: Inflammation can weaken the heart muscle and reduce its ability to pump blood effectively.
Atrial Fibrillation: Damage to the heart can contribute to an irregular heartbeat in the upper chambers.
Heart Failure: Severe heart damage can prevent the heart from pumping enough blood to meet the body's needs.
Stroke: Certain abnormal heart rhythms and severe valve disease can increase the risk of blood clots and stroke.

How Can Rheumatic Fever Be Prevented?

Prompt diagnosis and appropriate treatment of group A streptococcal infections are the most effective ways to prevent rheumatic fever.

Seek medical evaluation for persistent sore throat and other symptoms of strep infection
Start prescribed antibiotics promptly after a confirmed strep infection
Complete the full course of antibiotics as directed
Take long-term preventive antibiotics if recommended after rheumatic fever
Wash hands thoroughly and regularly
Avoid sharing food, drinks and personal items during infections
Clean frequently touched surfaces
Attend regular medical and heart check-ups after rheumatic fever

What Are the Do's and Don'ts for Rheumatic Fever?

Following treatment instructions and protecting against future streptococcal infections can help reduce the risk of recurrence and long-term heart damage.

Do's	Don'ts
Take antibiotics exactly as prescribed by the doctor	Stop antibiotics before completing the prescribed course
Seek prompt evaluation for future sore throats	Ignore symptoms of a possible streptococcal infection
Attend regular heart check-ups	Skip follow-up appointments
Follow medical advice about rest and physical activity	Perform strenuous exercise during the acute phase without medical approval
Maintain a balanced diet and adequate hydration	Self-medicate without consulting a healthcare provider

Frequently Asked Questions

1. What is the main cause of rheumatic fever?

Rheumatic fever is caused by an abnormal immune response after an infection with group A Streptococcus (group A strep), usually following inadequately treated strep throat, scarlet fever, or sometimes a strep skin infection.

2. What happens if you get rheumatic fever?

Rheumatic fever causes inflammation that can affect the heart, joints, brain, and skin. The most serious complication is permanent damage to the heart valves, known as rheumatic heart disease.

3. How is rheumatic fever diagnosed?

There is no single definitive test. Diagnosis is based on the Jones criteria, evidence of a recent group A strep infection, physical examination, blood tests, an electrocardiogram (ECG), and echocardiography when needed.

4. What is the temperature for rheumatic fever?

Fever is a common symptom, but there is no single temperature that confirms rheumatic fever. Under the Jones criteria, fever thresholds vary according to whether a person comes from a low-risk or moderate-to-high-risk population, and temperature must be considered with other clinical findings.

5. Which organ is most affected by rheumatic fever?

The heart is the most seriously affected organ, particularly the heart valves. The mitral valve is most commonly damaged, and repeated attacks can lead to permanent rheumatic heart disease.

6. What are the early signs of rheumatic fever?

Early signs may include fever, painful or swollen joints, fatigue, and symptoms developing several weeks after a strep infection. Other signs can include involuntary movements, a skin rash, subcutaneous nodules, chest pain, or shortness of breath if the heart is affected.