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 your heart, joints, brain, and skin.

How does it occur?

Rheumatic fever is a disease caused by a reaction to streptococcus bacteria. These bacteria are the same germs that cause strep throat. Exactly why and how some people have this reaction to strep bacteria is not well understood. It appears to involve an abnormal response of 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 several strep infections. It may occur 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
• tiredness
• shortness of breath
• jerky, uncontrollable movements of your face, arms, and legs
• fever
• abdominal pain.

Sometimes, but not commonly, there are pink or light red, nonitching blotches on your skin or small bumps under the skin on your 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 definitive test for rheumatic fever. The diagnosis is based on:

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

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
• a test called 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 to control fever, joint pain, and inflammation
• steroid drugs to treat inflammation of the heart
• medicine such as a tranquilizer to help control jerky movements
• bed rest until you have a normal temperature without medicine
• several weeks of decreased activity.

How long will the effects last?

Rheumatic fever can last from 6 weeks to more than 6 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 have to take penicillin regularly for months or years to prevent further strep infections.

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. Before you have surgery or dental work, take antibiotics as prescribed by your provider to prevent infection of the heart.
• Follow your provider's advice for decreased activity while you are recovering.
• Drink lots of fluids.
• Call your 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
  • a fever over 101.5°F (38.6°C) 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.