Rheumatic fever a disease marked by inflammation of tissue. The heart valves, skin, joints, and nerves can all be affected. Rheumatic fever can also cause lasting damage to the heart.
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Rheumatic fever is caused by the body's response to a type of bacteria. The bacteria causes strep throat. The body makes antibodies to fight the infection. These antibodies also begin to attack healthy tissue in the body. It is not clear why this happens.
Rheumatic fever is more common in children aged 5 to 15. Other things that raise the risk are:
- Having strep throat or scarlet fever, and
- Not being treated with antibiotics
- Not being adequately treated with antibiotics
- A history of rheumatic fever
- Crowded areas and living conditions
Symptoms usually appear 2 to 4 weeks after a strep infection. They may include:
- Pain in muscles or large joints
- Cough or problems breathing
- Chest pain
- Nausea and vomiting
- Lumps under the skin or a rash
- Abnormal, sudden movements of arms and legs
The doctor will ask about symptoms and past health. A physical exam will be done. This will include a careful exam of the heart. Tests will be done to look for signs of infection. Tests may include:
- Blood tests
- Throat culture—to test for types of bacteria
Images and tests of the heart may be done to look for any damage. Tests may include:
- Chest x-rays
- ECG—test electrical activity of heart
Most will begin treatment in the hospital. The goal of treatment is to kill the strep bacteria and stop the inflammation. It is also to ease symptoms. Other steps may be needed to help prevent future infections.
Other treatment may be needed to treat any heart problems.
Antibiotics are used to treat the strep infection. They may be given by mouth or injection. Antibiotics will also need to be taken for several years. It will help to prevent another strep infection. Repeated infections can cause more damage to the heart.
Joint pain and swelling may be managed with:
- Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs)
- Corticosteroids—if NSAIDs are not effective or if there is inflammation of the heart
Note: Aspirin can cause serious problems in some children with certain infections. It is best to avoid aspirin or aspirin products for children with infections.
Inflammation can be severe. It can cause joint soreness and stiffness. Rest may be needed for a period of time.
American Heart Association http://www.heart.org
National Heart, Lung, and Blood Institute https://www.nhlbi.nih.gov
Health Canada https://www.canada.ca
Heart and Stroke Foundation of Canada http://www.heartandstroke.ca
Acute rheumatic fever. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-rheumatic-fever. Accessed April 29, 2022.
Lahiri S, Sanyahumbi A. Acute rheumatic fever. Pediatr Rev. 2021;42(5):221-232.
Rheumatic fever. Texas Heart Institute website. Available at: https://www.texasheart.org/heart-health/heart-information-center/topics/rheumatic-fever. Accessed April 29, 2022.
- Reviewer: David L. Horn, MD, FACP
- Update Date: 04/29/2022