Overview, Causes, & Risk Factors
Rheumatic fever is a delayed immune response that can occur after certain group A streptococcal infections. It causes damage to certain organs, particularly the heart.
Strep throat and scarlet fever are two types of infections that precede rheumatic fever. If a person is not treated effectively with antibiotics for these infections, he or she may have an immune response. The effects of this response can be seen in the heart, joints, brain, and skin. The most serious effect of rheumatic fever is a heart valve defect known as mitral valve prolapse. Rheumatic fever was more common before antibiotics were available to treat infections.
Rheumatic fever is an immune response to an infection with group A streptococcus. The same bacteria causes strep throat and scarlet fever. While streptococcal skin infections are fairly common, they have not been linked to rheumatic fever.
Rheumatic fever is most prevalent in school-age children who are 5 to 15 years old. It is seen most often in the cold winter months when strep throat is also most common. Rheumatic fever may also occur in adults. It is seen with equal frequency in men and women. However, women with rheumatic fever are more likely to develop Sydenham chorea and mitral valve prolapse.
Rheumatic fever may develop suddenly 2 to 6 weeks after a streptococcal infection. This form of the disease is most common in older people. It generally starts with joint pain and fever. Rheumatic fever may also develop slowly, starting with a mild infection of the heart. This form of the disease is more common in children.
Symptoms of rheumatic fever vary, but may include the following:
Diagnosis of rheumatic fever starts with a medical history and physical examination. The healthcare provider may also order diagnostic tests. These may include the following:
The American Heart Association has issued guidelines for the diagnosis of rheumatic fever. Known as the Jones criteria, these guidelines include lab test findings as well as signs and symptoms of the disease.
Effective treatment of strep infections with antibiotics significantly lowers a person’s risk of developing rheumatic fever. Individuals with these infections should take their full course of antibiotics, even after symptoms are gone.
In 75% of people with rheumatic fever, the acute attack lasts only 6 weeks. Ninety percent of the cases of rheumatic fever resolve in 12 weeks or less. Fewer than 5% of people with rheumatic fever have symptoms that last for 6 months or more.
There are many possible complications as a result of rheumatic fever. They can include the following:
Rheumatic fever itself is not contagious and poses no risk to others. However, the streptococcal infection can be highly contagious.
A person with strep throat will be given antibiotics such as penicillin and erythromycin. Nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin and ibuprofen, may be used as needed for pain and fever. However, aspirin should not be used by children because of the risk for developing Reye syndrome.
A person who has rheumatic fever will be given antibiotics as well as NSAIDs. Corticosteroids, such as prednisone, may be used to modify the immune response. Bed rest is recommended for a person who has rheumatic fever. Some healthcare providers prescribe digoxin, a medicine that strengthens the contractions of the heart.
After the initial treatment, a slow increase in physical activity is allowed. Any complications are treated on a case-by-case basis.
Antibiotics and pain medicines may cause stomach upset, rash, and allergic reactions. Corticosteroids can increase the person’s risk of infection.
A person who has had rheumatic fever may need lifelong treatment with antibiotics to prevent further attacks. He or she may also be advised to take preventive antibiotics before surgery or dental procedures.
The healthcare provider will monitor a person for the complications of rheumatic fever. The provider may order repeated echocardiograms and other tests. Any new or worsening symptoms should be reported to the provider.