Rheumatic fever

Rheumatic fever is a rare autoimmune disease that primarily affects children and can lead to serious complications, including rheumatic heart disease. It's an inflammatory condition that develops as a complication to strep throat or a strep throat rash.

This condition, caused by strep bacteria (group A streptococcus), can lead to inflammation around the heart, joints and skin and even lead to muscle pain and severe fever.

Our team of rheumatologists is here to support you every step of the way, helping you understand rheumatic fever, treat it effectively and prevent it from coming back. And if you need immediate help, we’re here to help you find immediate care that's right for you.

What is rheumatic fever?

Rheumatic fever develops when strep throat is untreated or not properly treated, causing inflammation in your joints, heart or on your skin in the form of a rash.

But it’s not the strep throat infection itself that causes rheumatic fever – it’s the immune system’s response to the bacteria. Normally, your immune system works as your body’s defense, attacking and killing bacteria and viruses. In the case of rheumatic fever, the immune system attacks healthy tissue instead.

How often does strep throat lead to rheumatic fever?

While strep throat is a common infection among children, it rarely leads to rheumatic fever if treated quickly. However, if the infection is left untreated or not treated thoroughly, chances of developing rheumatic fever increase.

Rheumatic fever symptoms

Rheumatic fever symptoms can vary widely from person to person, making it a challenging condition to diagnose. A high, persistent fever is one of the first signs of rheumatic fever.

Common signs include:

• Joint pain and swelling: Painful and swollen joints, particularly in the knees, ankles, elbows and wrists, are typical. The pain may move from one joint to another.
• Rash: A distinctive rash can appear, typically as pink rings with clear centers. This type of rash often goes unnoticed because it doesn’t itch or cause pain.
• Heart complications: Inflammation of the heart can occur, leading to chest pain, shortness of breath and heart murmurs. This can progress to rheumatic heart disease if left untreated.
• Chorea: Sudden, involuntary movements, particularly in the face and hands, are common symptoms in children. Chorea is a type of dyskinesia.
• Nodules: Small, painless lumps may appear under the skin.

Recognizing these symptoms early is important to ensure you get timely rheumatic fever treatment. If you notice any of these symptoms, contact your doctor as soon as possible or visit an immediate care center.

Complications of rheumatic fever

One of the most concerning outcomes is rheumatic heart disease, which occurs when the inflammation caused by rheumatic fever leads to permanent damage to the heart valves. This can result in lifelong heart problems that may require surgery later in life.

Other complications include recurring episodes of rheumatic fever, which can make the damage to your heart worse, and chronic joint pain or arthritis.

How long does it take for rheumatic fever to affect the heart?

The heart can be affected quickly after rheumatic fever symptoms are noticeable. Inflammation of the heart can develop within weeks of the initial strep infection. The extent of damage depends on how quickly the condition is diagnosed and treated.

How quickly does rheumatic fever progress?

Rheumatic fever typically develops about two to four weeks after a strep throat infection. How fast it progresses depends on your health and the severity of your initial infection. The most immediate concern is inflammation of the heart and joints, which can cause a lot of discomfort and long-term damage.

Diagnosing rheumatic fever

Your doctor will do a physical exam and review your medical history. They’ll also go over your symptoms with you, including checking for a fever and asking if you’ve had any joint pain. They may also order blood tests to check for inflammation and antibodies to strep bacteria to confirm a diagnosis.

In cases where rheumatic fever has affected the heart, an echocardiogram or other imaging tests may be used to check for heart failure and damage to your heart valves.

Rheumatic fever treatments

Rheumatic fever treatment aims to kill strep bacteria, reduce inflammation and manage symptoms.

Your doctor may recommend anti-inflammation medications, such as ibuprofen or aspirin, and prescribe antibiotics. Long-term antibiotics such as prophylaxis may be recommended to prevent rheumatic fever from coming back. It’s important to let your doctor know of any drug allergies, especially to penicillin or other antibiotics.

In severe cases, strict bed rest at home or in the hospital may be advised to reduce strain on your heart. If you do have rheumatic heart disease, ongoing management may be needed, including medications to manage heart failure symptoms, such as swollen legs and ankles, difficulty breathing and fatigue. Heart surgery may be needed in some cases.