About Rheumatic Fever

Key points

  • Rheumatic fever is an inflammatory condition that can affect the heart, joints, brain, and skin.
  • Rheumatic fever can develop if strep throat, scarlet fever, or impetigo aren't treated properly.
  • Symptoms often include fever and painful, tender joints.
  • Treatment focuses on managing inflammation and symptoms.
  • Serious complications include long-term heart damage.
A doctor looks over results from a child’s electrocardiogram

What it is

Rheumatic fever is a condition that can inflame or make the heart, joints, brain, and skin swell. It's thought to be an immune response to an earlier bacterial infection.

As the body's defense system, the immune system is important in fighting off infections. But when the immune system mistakenly attacks healthy parts of the body, it causes inflammation (swelling).

Rheumatic fever can develop after infections caused by group A Streptococcus (group A strep bacteria), specifically:


Rheumatic fever can develop about 1 to 5 weeks after a group A strep infection.

Common symptoms

Symptoms can include:

  • Arthritis (painful, tender joints)
  • Chorea (jerky, uncontrollable body movements)
  • Fatigue (tiredness)
  • Fever

Arthritis is most common in the knees, ankles, elbows, and wrists.

Uncommon symptoms

Rarely, symptoms can include:

  • Nodules (painless lumps) near joints
  • Rash with pink rings and a clear center

Heart-related symptoms

Symptoms of rheumatic fever can also include symptoms of congestive heart failure:

  • Chest pain
  • Fast heartbeat
  • Shortness of breath

In addition, someone with rheumatic fever can have:

  • A new heart murmur
  • An enlarged heart
  • Fluid around the heart


If rheumatic fever is not treated promptly, rheumatic heart disease may occur. Rheumatic heart disease weakens the valves between the chambers of the heart. Severe rheumatic heart disease can require heart surgery and result in death.

Risk factors

Anyone can get rheumatic fever after having strep throat, scarlet fever, or impetigo. Some factors can increase the risk of getting it.


Rheumatic fever is more common in children than adults.

  • Most common: School-age children (5 through 15 years old)
  • Rare: Children younger than 3 years old and adults

Group settings

Crowded conditions can increase the risk of getting strep throat, scarlet fever, or impetigo. Thus, these settings can increase the risk for rheumatic fever if those infections are not treated properly. These settings include:

  • Daycare centers and schools
  • Detention or correctional facilities
  • Homeless shelters
  • Military training facilities

Other health factors

Someone who had rheumatic fever is more likely to get it again if they get another group A strep infection.

How it spreads

People can't catch rheumatic fever from someone else because it's an immune response, not an infection. However, if someone with rheumatic fever is still infected with group A strep bacteria, they can spread the bacteria to others. Group A strep bacteria are contagious.


There are things people can do to protect themselves and others from group A strep infections. Preventive antibiotics also help protect people with rheumatic fever from getting it again.

Testing and diagnosis

There's no single test used to diagnose rheumatic fever. Instead, healthcare providers can look for signs of illness and check the patient's medical history. They can also use many tests, including:

  • Blood test to look for antibodies of a recent group A strep infection
  • Echocardiography or echo (to see the heart muscle working)
  • Electrocardiogram or EKG (a test of how well the heart is working)
  • Throat swab to look for a group A strep infection

Treatment and recovery

Healthcare providers treat symptoms of rheumatic fever with medicines to reduce

  • Fever
  • Inflammation
  • Pain

In addition, all patients with rheumatic fever should get antibiotics that treat group A strep infections.

People who develop rheumatic heart disease with symptoms of heart failure may require medicines to help manage this as well.