Rheumatic Fever: All You Need to Know

A young boy holds his elbow as if in pain

Rheumatic fever (acute rheumatic fever) is a condition that can affect the heart, joints, brain, and skin. Rheumatic fever can develop if strep throat, scarlet fever, and strep skin infections are not treated properly.

Rheumatic fever is an inflammatory condition

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

How you get rheumatic fever

Rheumatic fever may develop if strep throat or scarlet fever infections are not treated properly or after strep skin infections (impetigo). Bacteria called group A Streptococcus (group A strep) cause these infections. It usually takes about 1 to 5 weeks after one of these infections for rheumatic fever to develop.

Rheumatic fever is not contagious

People cannot catch rheumatic fever from someone else because it is an immune response and not an infection. However, people with a group A strep infection can spread the bacteria to others.

Fever and painful, tender joints are common symptoms

Symptoms of rheumatic fever can include:

  • Fever
  • Arthritis (painful, tender joints), most commonly in the knees, ankles, elbows, and wrists
  • Symptoms of congestive heart failure, including chest pain, shortness of breath, fast heartbeat
  • Fatigue (tiredness)
  • Chorea (jerky, uncontrollable body movements)

Rarely, symptoms can include nodules (painless lumps) near joints or a rash that has pink rings with a clear center.

In addition, someone with rheumatic fever can have:

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

Some people are at increased risk

Anyone can get rheumatic fever after having strep throat, scarlet fever, or impetigo. There are some factors that can increase the risk of getting rheumatic fever.

Age

Rheumatic fever is more common in school-age children (5 through 15 years old). Rheumatic fever is very rare in children younger than 3 years old and adults.

Group settings

Infectious illnesses, including group A strep infections, tend to spread wherever large groups of people gather. Crowded conditions can increase the risk of getting strep throat, scarlet fever, or impetigo, and thus rheumatic fever if they are not treated properly. These settings include:

  • Schools
  • Daycare centers
  • Military training facilities

Other health factors

Someone who had rheumatic fever in the past is more likely to get rheumatic fever again if they get strep throat, scarlet fever, or impetigo again.

A doctor looks over results from a child’s electrocardiogram

Doctors look to see how well the heart is working when diagnosing rheumatic fever.

Many tests, considerations help doctors diagnose rheumatic fever

There is no single test used to diagnose rheumatic fever. Instead, doctors can look for signs of illness, check the patient’s medical history, and use many tests, including:

  • A throat swab to look for a group A strep infection
  • A blood test to look for antibodies to see if the patient recently had a group A strep infection
  • Electrocardiogram or EKG (a test of how well the heart is working)
  • Echocardiography or echo (a test that creates a movie of the heart muscle working)

Treatment focuses on managing inflammation, symptoms

Doctors treat symptoms of rheumatic fever with medicines to reduce fever, pain, and general inflammation.

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

People who develop rheumatic heart disease (long-term heart damage) with symptoms of heart failure may require medicines to help manage this as well.

Serious complications include long-term heart damage

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.

Protect yourself and others

Having a group A strep infection does not protect someone from getting infected again in the future. People can also get rheumatic fever more than once. However, there are things people can do to protect themselves and others.

Good hygiene

The best way to keep from getting or spreading group A strep bacteria is to wash your hands often. This is especially important after coughing or sneezing and before preparing foods or eating.

Preventive antibiotics

The main ways to prevent rheumatic fever are to

  • Treat group A strep infections with antibiotics
  • Prevent group A strep infections in the first place
  • Use preventive antibiotics for people who had rheumatic fever in the past

Preventive antibiotics help protect people who had rheumatic fever from getting it again. Doctors also call this prophylaxis (pro-fuh-LAK-sis) or “secondary prevention.”

People may need antibiotic prophylaxis over a period of many years (often until 21 years old). Prophylaxis can include daily antibiotics by mouth or a shot into the muscle every few weeks.