Rheumatic Fever

Rheumatic fever is an inflammatory disease which may develop after an infection with streptococcus bacteria (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain.

Rheumatic fever is common worldwide and is responsible for many cases of damaged heart valves. While it is far less common in the U.S. since the beginning of the 20th century, there have been a few outbreaks since the 1980s.

Rheumatic fever primarily affects children between ages 6 and 15 and occurs approximately 20 days after strep throat or scarlet fever. In up to a third of cases, the underlying strep infection may not have caused any symptoms.

The rate of development of rheumatic fever in individuals with untreated strep infection is estimated to be 3%. Persons who have suffered a case of rheumatic fever have a tendency to develop flare-ups with repeated strep infections.

Symptoms of rheumatic fever include fever, joint pain, migratory arthritis -- involving primarily knees, elbows, ankles, and wrists, joint swelling; redness or warmth, abdominal pain, skin rash (erythema marginatum), skin nodules, sydenham's chorea -- emotional instability, muscular weakness and rapid, uncoordinated jerky movements affecting primarily the face, feet and hands, epistaxis (nosebleeds), cardiac (heart) involvement which may be asymptomatic or may result in shortness of breath, and chest pain.

Given the different manifestations of this disease, there is no specific test which can definitively establish a diagnosis. In addition to a careful physical examination of heart sounds, skin, and joints, blood samples may be taken as part of the evaluation. These include tests for recurrent strep infection (ASO or antiDNAse B), complete blood counts, and sedimentation rate (ESR). As part of the cardiac evaluation, an electrocardiogram may also be done.

In order to standardize the diagnosis of rheumatic fever, several minor and major criteria have been developed. These criteria, in conjunction with evidence of recent streptococcal infection, establish a diagnosis of rheumatic fever.

The management of acute rheumatic fever is geared towards the reduction of inflammation with anti-inflammatory medications such as aspirin or corticosteroids. Individuals with positive cultures for strep throat should also be treated with antibiotics. Another important cornerstone in treating rheumatic fever includes the continuous use of low dose antibiotics (such as penicillin, sulfadiazine, or erythromycin) to prevent recurrence.

The recurrence of rheumatic fever is relatively common in the absence of maintenance of low dose antibiotics, especially during the first 3 to 5 years after the first episode of rheumatic fever. Heart complications may be long-term and severe, particularly if the heart valves are involved.

Links to Rheumatic Fever

  • Rheumatic Fever :Overview page providing important information on this topic.
  • Information from the Mayo Clinic: Rheumatic fever is a serious inflammatory condition that can affect many parts of your body — heart, joints, nervous system and skin. Although rheumatic fever can occur at any age, it most frequently occurs in children between the ages of 6 and 15 years. The disease is twice as common in females as it is in males.
  • General overview of Rheumatic Fever
  • Acute Rheumatic Fever: Acute rheumatic fever (ARF) is a complication of a strep throat caused by particular strains of GAS. Although common in developing countries, ARF is rare in the United States, with small isolated outbreaks reported only occasionally.
  • Rheumatic Fever-Keep Kids Healthy
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