Rheumatic Fever

What is rheumatic fever?

Rheumatic fever is a disease that causes inflammation (swelling and redness) of various parts of the body. The disease can damage the heart, joints, brain, and skin.

What is the cause?

Rheumatic fever is caused by a reaction to a strep throat infection. Why some people have this reaction to strep bacteria is not well understood. It appears to be a response by the body's immune system.

Most people with strep throat do not get rheumatic fever. You are more at risk for rheumatic fever if you have had:

• an untreated strep infection
• an incompletely treated infection because you didn’t finish all of the medicine prescribed for you, or
• several strep infections

You can have rheumatic fever at any age, but it is most common in children.

What are the symptoms?

Symptoms, which usually begin 2 to 3 weeks after a sore throat, may include:

• aching and swollen joints (ankles, knees, elbows, wrists), with the pain and swelling often moving from joint to joint
• fever
• tiredness
• chest pain
• shortness of breath
• jerky, uncontrollable movements of your face, arms, and legs
• red, flat, painless, and nonitching rash on the chest and belly or arms and legs
• small bumps under the skin on the elbows or knees

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and will examine you. There is no single test for rheumatic fever. The diagnosis is based on:

• history of a previous strep throat infection
• symptoms
• evidence of heart inflammation
• lab tests

You may have tests such as:

• a blood test to look for antibodies to the strep bacteria
• a chest X-ray
• an ultrasound scan of the heart (echocardiogram)
• an electrocardiogram (ECG) to check for abnormal heartbeats and rhythms

How is it treated?

Your healthcare provider may prescribe:

• penicillin or another antibiotic to kill the strep bacteria
• aspirin or another anti-inflammatory medicine to control fever, joint pain, and inflammation
• steroid drugs to treat inflammation of the heart
• medicine to help control jerky movements
• bed rest until you have a normal temperature without medicine
• several weeks of decreased activity

Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye's syndrome. Aspirin is a nonsteroidal anti-inflammatory medicine (NSAID). NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take NSAIDs for more than 10 days for any reason.

Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.

How long will the effects last?

Rheumatic fever can last from several weeks to more than several months. Your long-term health depends on how the heart has been affected by the disease. Inflammation caused by rheumatic fever can weaken the heart muscle and affect the heart's ability to pump. The heart valves may also be affected. One or more valves may become scarred and after a while may have trouble opening and closing properly. Damage to the valves may not show up until years after the illness. Eventually, the valve may need to be repaired or replaced with surgery. Starting antibiotic treatment early when you have rheumatic fever may prevent permanent damage to the heart.

It is very important to prevent recurrences of rheumatic fever because the severity of heart trouble is related to the number of attacks of rheumatic fever. You may need to take penicillin regularly for months or years to keep from getting more strep infections. How long you will need to take preventive penicillin (or a different antibiotic if you are allergic to penicillin) depends on many factors. The recommendations change every few years as more is learned about how to prevent and treat the complications of rheumatic fever. Be sure to see your healthcare provider at least yearly, and stay up-to-date on the current recommendations for prevention of recurrences of rheumatic fever.

How can I take care of myself?

• Make sure that you take the full course of antibiotics prescribed by your healthcare provider.
• Damaged valves may become infected if they are exposed to bacteria during surgery or dental work. Infection of the valve can damage it more. Antibiotics can help prevent infection. Ask your healthcare provider if you should take antibiotics before you have dental work or medical procedures.
• Follow your provider's advice for decreased activity while you are recovering.
• Call your healthcare provider if you have:
  • a sore throat again
  • upset stomach, ringing in the ears, headaches, or very fast breathing, which may be reactions to taking aspirin often
  • trouble breathing
  • pain near your heart
  • lack of energy and tiredness
  • a fever of 101.5°F (38.6°C) or higher even though you are taking your prescribed medicine

How can I help prevent rheumatic fever?

Tell your healthcare provider if you have a sore throat and fever that last more than 24 hours, or if you have a severe sore throat without cold symptoms. If you have been exposed to someone with a strep throat and you now have a sore throat, see your provider. Treating strep throat infections with antibiotics can usually prevent rheumatic fever.