Rheu­ma­tic fe­ver

Rheumatic fever
Rheumatic fever

Rheumatic fever is an inflammatory disease that often involves joints, heart, skin and brain. It typically develops two to four weeks after an inadequately treated strep throat or scarlet fever caused by an infection with group A streptococcus bacteria. Rheumatic fever is most common in 5- to 15-year-old children, but it might also develop in younger kids and adults. Although rare in western countries, the disease remains common in the developing world. It may lead to permanent damage to the heart, such as damaged heart valves and heart failure. Therapy mostly reduces tissue damage from inflammation, eases pain, and stops rheumatic fever from coming back. 

Symptoms of rheumatic fever
  • Fever
  • Fatigue
  • Heart problems (e.g. heart murmur)
  • Shortness of breath
  • Chest pain
  • Joint pain (mainly in the knees, elbows, ankles, wrists)
  • Red, swollen or hot joint
  • Nosebleeds
  • Flat or slightly raised, painless rash with a ragged edge – on the trunk and upper part of the arms or legs
  • Small, painless lumps beneath the skin
  • Jerky, uncontrollable body movements that mainly affect the face, feet, and hands)

Signs of rheumatic heart disease (that may take a long time to develop after a previous episode of rheumatic fever):

  • Dizziness
  • Fatigue
  • Chest pain
  • Shortness of breath

Causes and origin of rheumatic fever

The disease may occur after a throat infection with group A streptococcus bacteria that might cause strep throat, or scarlet fever. Although the link between strep infection and rheumatic fever is not yet understood in detail, researchers know that the bacterium contains a protein similar to one discovered in certain body tissues. Therefore, immune system cells treat tissues of the joints, heart, skin and central nervous system as if they were infectious agents. The immune system reacts with inflammation.

As long as the patient is diagnosed immediately and treated completely with antibiotics to eliminate strep bacteria, he/she usually doesn’t develop rheumatic fever. However, if the patient has one or more episodes of strep throat or scarlet fever that aren't treated properly, he/she may develop rheumatic fever.

Risk factors for developing rheumatic fever:

  • Gene/s carried by some people that may lead to rheumatic fever
  • Certain strains of strep bacteria that are more likely to contribute to rheumatic fever than other strains
  • Areas with overcrowding, poor sanitation and other conditions that can quickly result in rapid transmission or multiple exposures to strep bacteria
Fever is one of the symptoms
Fever is one of the symptoms

Consequences of rheumatic fever
  • Rheumatic heart disease – develops when inflammation results in damage and stiffness of the valves in the heart, i.e. when the normal flow of blood through the heart is disrupted
  • Atrial fibrillation – leads to irregular and often abnormally fast heart rate and increased risk of a stroke.
  • Heart failure – occurs when the heart becomes so damaged that it cannot pump enough blood around the body


Prevention and therapy of rheumatic fever

Patients with acute rheumatic fever are treated with antibiotics. In addition, anti-inflammatory medications, e.g. aspirin or corticosteroids reduce inflammation and help manage the disease. In quite a few cases, the affected person has to take low doses of antibiotics over a long period of time to prevent strep throat from coming back.

If the patient also suffers from mild rheumatic heart disease, he/she can normally be treated e.g. with ACE inhibitors that relax the arteries. In this way, it’s easier for the heart to pump blood around the body.
People with atrial fibrillation get medication to control the heart rate or rhythm, and medicaments to prevent a stroke.

Heart failure often requires surgery. The surgeons replace the damaged valve with an artificial one or they expand the valve with a tiny balloon.
If a patient has had rheumatic fever before, he/she might need antibiotics during surgery to protect the heart valves from becoming infected.

Preventive measures

If strep throat infections or scarlet fever are promptly treated and the patient takes a full course of appropriate antibiotics, rheumatic fever can be prevented.