Rheumatic Fever

Rheumatic fever is a complication of untreated strep throat that can be life-threatening. Thanks to antibiotics, rheumatic fever is rare in the U.S. and other developed countries. It can cause permanent damage to the heart and heart failure. It is most common in children ages 5 to 15 years old.

Rheumatic fever is an inflammation in the heart, joints, skin or central nervous system that can occur following inadequately treated strep throat or scarlet fever. These diseases are caused by an infection of Group A streptococcus bacteria. Proper treatment of strep can prevent rheumatic fever.

Doctors aren’t sure why there is a link between the strep bacteria and rheumatic fever. The strep bacteria seems to trick the immune system into attacking certain body tissues, which causes the fever. The resulting inflammation can cause long-term problems, including rheumatic heart disease.

Rheumatic fever usually occurs about two to four weeks after a strep throat infection, and can be so mild you don’t even know you have it. 
The symptoms vary and may include:

• Fever.
• Painful and tender joints, most often the ankles, knees, elbows or wrists.
• Pain that moves from joint to joint.
• Red, hot or swollen joints.
• Small, painless nodules under the skin.
• Chest pain.
• Heart murmur.
• Fatigue.
• Flat or slightly raised painless rash.

Rheumatic fever can also cause a temporary disorder of the nervous system. Symptoms include:

• Jerky, uncontrollable body movements in the hands, feet and face.
• Bursts of unusual behavior, such as crying or inappropriate laughing.

Doctors diagnose rheumatic fever based on a physical examination. The doctor will check for fever, joint inflammation, rash or nodules under the skin, abnormal heart rhythms or murmur and signs of nerve inflammation, which is done by performing a few simple movement tests.

If strep throat was previously diagnosed and treated, the doctor will order a blood test that will look for antibodies related to the infection in the blood. Heart function may be examined using tests such as an electrocardiogram (EKG) and echocardiogram.
 

The goals of treatment are to destroy bacteria, relieve symptoms and prevent recurrences. Treatment often include:

• Antibiotics, such as penicillin, to eliminate any remaining strep bacteria.
• Long-term antibiotic treatment to prevent recurrence.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, to reduce inflammation and pain
• Corticosteroids, such as prednisone, may be used if inflammation is severe
• Other medications may be given to reduce severe involuntary movements

If heart tissue is affected by inflammation, strict bed rest is necessary for a few weeks or months until symptoms improve. Long-term follow-up care is necessary, as permanent heart damage may show up well after the acute fever phase of the disease has gone away. If your child has had rheumatic fever, it is important to include this in his or her medical history even when they reach adulthood, as they will need regular heart exams.