Rheumatic Fever: All You Need to Know

A young boy holds his elbow as if in pain

Rheumatic fever (acute rheumatic fever) is a disease that can affect the heart, joints, brain, and skin. Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly. Early diagnosis of these infections and treatment with antibiotics are key to preventing rheumatic fever.

How You Get Rheumatic Fever

Rheumatic fever may develop after strep throat or scarlet fever infections that are not treated properly. Bacteria called group A Streptococcus or group A strep cause strep throat and scarlet fever. It usually takes about 1 to 5 weeks after strep throat or scarlet fever for rheumatic fever to develop. Rheumatic fever is thought to be caused by a response of the body’s defense system — the immune system. The immune system responds to the earlier strep throat or scarlet fever infection and causes a generalized inflammatory response.

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 strep throat or scarlet fever can spread group A strep to others, primarily through respiratory droplets.

Fever and Painful, Tender Joints Are Common Signs and Symptoms

Symptoms of rheumatic fever can include:

  • Fever
  • Painful, tender joints (arthritis), most commonly in the knees, ankles, elbows, and wrists
  • Symptoms of congestive heart failure, including chest pain, shortness of breath, fast heartbeat
  • Fatigue
  • Jerky, uncontrollable body movements (called “chorea”)
  • Painless lumps (nodules) under the skin near joints (this is a rare symptom)
  • Rash that appears as pink rings with a clear center (this is a rare symptom)

In addition, someone with rheumatic fever can have:

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

Children Most Often Affected

Although anyone can get rheumatic fever, it is more common in school-age children (5 through 15 years old). Rheumatic fever is very rare in children younger than three years old and adults.

Infectious illnesses, including group A strep, tend to spread wherever large groups of people gather together. Crowded conditions can increase the risk of getting strep throat or scarlet fever, and thus rheumatic fever. These settings include:

  • Schools
  • Daycare centers
  • Military training facilities

Someone who had rheumatic fever in the past is more likely to get rheumatic fever again if they get strep throat or scarlet fever 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 that would show if the patient recently had a group A strep infection
  • A test of how well the heart is working (electrocardiogram or EKG)
  • A test that creates a movie of the heart muscle working (echocardiography or echo)

Treatment Focuses on Managing Inflammation, Symptoms

Doctors treat symptoms of rheumatic fever with medicines like aspirin 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 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, long-term heart damage (called 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 Helps Prevent Group A Strep Infections

The best way to keep from getting or spreading group A strep infections such as strep throat or scarlet fever is to wash your hands often, especially after coughing or sneezing and before preparing foods or eating.

Antibiotics Are Key to Treatment and Prevention

The main ways to prevent rheumatic fever are to

  • Treat group A strep infections like strep throat and scarlet fever 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.

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