Rheumatic Fever: Risk Factors, Warning Signs, and Recovery

Rheumatic fever is an inflammatory disease that develops when streptococcal A infections, such as strep throat, scarlet fever, and cellulitis, aren’t properly treated. Rheumatic fever can cause a variety of symptoms, including fever, painful joints, chest pain, and movement disturbances.

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 that can lead to rheumatic heart disease and other long-term complications if left untreated.

This article explains the causes and symptoms of rheumatic fever. It covers the possible complications that can result from untreated rheumatic fever, treatments, and more.

What Are the Signs of Rheumatic Fever? 

Rheumatic fever is thought to be an inflammatory immune response to a past infection. It can cause swelling in the heart, joints, brain, and skin, which can result in a variety of symptoms.

Symptoms of rheumatic fever may include:

• Fever
• Fatigue
• Painful, tender joints (arthritis), often in the knees, ankles, elbows, and wrists
• Symptoms of congestive heart failure, such as chest pain, shortness of breath, and fast heartbeat
• Jerky, uncontrolled movements, known as Sydenham chorea
• A new heart murmur
• An enlarged heart
• Fluid around the heart

Although rare, some people with rheumatic fever may develop painless lumps near joints, or a rash that has irregularly shaped pink rings with a clear center. This rash most often appears on the trunk, inner arms, and thighs. It is usually painless and non-itchy.

Complications

Rheumatic fever may cause inflammation and scarring in the heart valves. As a result, the valves can weaken and leak. Left untreated, this can lead to heart failure. Some people may require heart surgery, which may result in death.

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 are typically not permanent.

What Causes Rheumatic Fever?

Rheumatic fever typically occurs when a streptococcal infection, such as strep throat or scarlet fever, goes untreated, causing 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 itself. The streptococcal infections that cause rheumatic fever, however, are quite transmissible. 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 United States, it’s most common in people who live in poverty and have limited access to proper medical care, but it is still considered rare overall.

Diagnosing Rheumatic Fever

Rheumatic fever can’t be diagnosed by a simple blood test. If a healthcare provider 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 major criteria below or one major and two minor criteria below.

Tests your healthcare provider 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

Is Rheumatic Fever Treatable?

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.

Summary

Rheumatic fever is an inflammatory illness that can develop following a streptococcal infection. Symptoms usually develop within one to five weeks after the initial infection and may include fever, fatigue, painful joints, and a widespread rash. Left untreated, rheumatic fever can weaken and damage heart valves, and may lead to heart failure. A diagnosis of rheumatic fever is based on an evaluation of symptoms and tests that look for evidence of a previous streptococcal infection. To prevent complications, treatment will involve antibiotics, which may need to be taken long-term.