Rheumatic fever

Rheumatic fever is an inflammatory disease which occurs as a result of untreated Strep infection. The condition most commonly affects the children between 5 and 15 years. It affects the heart, joints, skin, and central nervous system and sometimes, leads to rheumatic heart disease.

It is estimated that there are nearly 470 000 newly diagnosed cases of rheumatic fever every year. The incidence of the disease is approximately 19 per 1, 00,000 per annum worldwide.


Rheumatic fever is an infection caused by group A Streptococcus or Streptococcus pyogenes. The exact association between group A streptococcus and rheumatic fever is still unclear. However, experts believe that the bacterium attacks the immune system. In response to Streptococcus infection, the body produces antibodies that fight against the bacteria. Sometimes, these antibodies affect the tissues of your joints or the heart leading to rheumatic fever.


If the condition is left untreated, it can lead to long-term complications.

Rheumatic fever affects your heart and causes permanent damage that leads to rheumatic heart disease, valve stenosis, valve regurgitation, and damage to the heart muscle.

Damage to the heart valves or other heart tissues may lead to certain heart problems later in life, such as atrial fibrillation and heart failure.

Risk factors

The risk of developing rheumatic fever increases with the following factors:

  • Family history of rheumatic fever
  • Increased susceptibility to Streptococcus infection
  • Environmental factors such as poor sanitation and overcrowding

Your doctor confirms the diagnosis based on the physical examination, medical history, and certain tests. Physical examination involves checking your joints for inflammation, identifying the nodules under the skin or skin rash, and checking for fever. Other diagnostic tests would include:

  • Blood test : Your blood sample is drawn and examined for the presence of antibodies to the Streptococcus bacterium.
  • Electrocardiogram (ECG) : It records the electrical signals of the heart. The test identifies the inflammation of the heart and the functioning of the heart.
  • Echocardiography : The test provides the detailed images of the heart. It is used to determine any damage to the heart valves in the early stages.

The primary goals of the treatment involve relieving the symptoms, destroying the group A streptococcal bacteria, and preventing the recurrence of the disease. Your doctor might recommend the following treatment options:

Antibiotics : Your doctor may prescribe penicillin antibiotics to eradicate the bacteria. After completion of penicillin therapy, your doctor might order another course of antibiotics to prevent the recurrence of the infection.
Anti-inflammatory therapy : Your doctor might order pain relievers such as aspirin or naproxen. These drugs reduce the inflammation, fever, and pain. In severe conditions, corticosteroids such as prednisone may be prescribed.
Anticonvulsant drugs : If there are severe jerky and involuntary body movements, your doctor might recommend anticonvulsant drugs such as valproic acid or carbamazepine.

The onset of symptoms usually occurs after two to four weeks of infection. The signs and symptoms vary individually and would include the following:

  • Fever
  • Painful joints (such as ankles, knees, elbows or wrists; less often in shoulders, hips, hands and feet)
  • Pain in one joint that radiates to another joint
  • Red, warm or swollen joints
  • Formation of small, painless nodules beneath the skin
  • Chest pain
  • Fatigue
  • Flat or slightly raised, painless rash
  • Difficulty swallowing
  • Thick, bloody discharge from nose
  • Sore throat
  • High body temperature (>101°F)
  • Uncontrollable and jerky muscle movements (most often in the hands, feet, and face)
  • Headache
  • Nausea and vomiting
  • Shortness of breath