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Rheumatic Fever

Definition :
Rheumatic fever is an inflammatory disease that can develop as a rare complication of untreated or undertreated strep throat infection. Strep throat is caused by infection with group A streptococcus. Rheumatic fever is most common in children between the ages of 5 and 15 years, though it can develop in adults, and can cause damage to the heart, joints, the brain and spinal cord, and the skin.

Symptoms of rheumatic (roo-MAT-ik) fever generally appear within a few weeks after a strep throat infection. In the United States, most cases of strep throat don't lead to rheumatic fever. Even in untreated cases, only a small percentage of people with strep throat develop rheumatic fever.

There's no cure for rheumatic fever. But it can be prevented by prompt and complete treatment of a strep throat infection with antibiotics.

Permanent heart damage resulting from rheumatic fever is called rheumatic heart disease. Rheumatic fever commonly damages the heart valves (rheumatic carditis) and can interfere with normal blood flow through the heart.

Rheumatic fever isn't as common in the United States today as it was at the start of the 20th century, before the widespread use of the antibiotics. Outbreaks do occur periodically, however. Rheumatic fever is still common in developing countries.

The exact cause of rheumatic fever isn't clear. Medical research has focused on an abnormal immune system response to the antigens produced by specific types of streptococcal bacteria. In addition, researchers are studying whether some people have a greater genetic disposition for an abnormal immune system response to streptococcal antigens.

When to seek medical advice :
If you or your child has symptoms of strep throat, or has had a recent sore throat and high fever and is now experiencing difficulty breathing or chest pain, see a doctor. Although most of the time strep throat doesn't lead to rheumatic fever, you can usually prevent rheumatic fever by treating strep throat with antibiotics.

Signs and symptoms of rheumatic fever may include :

  • Painful, swollen joints
  • Chest pain
  • Fatigue
  • Shortness of breath
  • Faint pink or red rash
  • Jerky body movements
  • Fever

To diagnose rheumatic fever, doctors generally look for evidence of a preceding strep throat infection, which is characterized by :

  • Sore throat
  • Red and swollen tonsils
  • Fever
  • Fatigue
  • Abdominal pain (in younger children)
  • Tender lymph nodes in the front of the neck
  • Headache
  • Muscle aches

In some cases, the initial strep infection may not cause any symptoms.

Diagnosis of rheumatic fever will likely involve a physical examination and questions about your symptoms. The physical exam may include :

  • Checking the joints for pain and inflammation
  • Examining the skin for rashes or lumps
  • Listening to the heart for abnormal rhythms or murmurs
  • Doing a neurological exam to check for abnormal movements

Your doctor may recommend an electrocardiogram (ECG) to check for abnormal rhythms. Electrocardiography involves attaching electrode patches to the skin to measure electrical impulses given off by the heart. The electrical impulses, which cause the heart muscle to contract, are recorded by an electrocardiograph machine. They typically are recorded in the form of waves, which are displayed on graph paper or on a monitor.

There is no lab test that can confirm rheumatic fever. Doctors base a diagnosis of rheumatic fever on the presence of certain criteria. The most common major criteria are :

  • Joint pain and swelling that moves from joint to joint
  • Inflammation of the heart

Diagnosing rheumatic fever requires not only the presence of key signs and symptoms but also evidence of a recent strep infection. A blood sample may be taken to test for the presence of antibodies to streptococcal bacteria. However, it's possible by then, the throat culture test for strep will be negative. In that case, the only suggestion of strep may be you telling the doctor about recent symptoms.

Complications :
Rheumatic heart disease. During a first rheumatic fever attack, about half of people develop heart inflammation, but this doesn't always result in permanent damage. Most people with rheumatic fever recover fully after six weeks. In some cases, however, one or more of the heart's valves may be scarred. Permanent heart damage due to rheumatic fever is known as rheumatic heart disease. In many cases, heart damage isn't discovered until years later.

In rare cases of rheumatic fever, the inflammation causes so much damage to the heart muscle that it leads to heart failure. In other cases, a scarred heart valve may prevent adequate blood flow or not seal tightly. If there's serious impairment to the function of affected heart valves, surgery may be needed to repair or replace the damaged valve or valves.

Other complications. Rheumatic fever can also affect these parts of the body :

  • Joints. Often, several joints are affected with painful swelling, redness and sensation of heat.
  • Brain. If acute rheumatic fever affects the brain, loss of coordination and uncontrolled movement of the limbs and face may occur. These movements are called chorea — from the Greek word "choreia," which means "choral dance." They're also sometimes called Sydenham's chorea, rheumatic chorea or St. Vitus' dance. Chorea occurs in about one in 10 rheumatic fever cases. Chorea usually subsides or disappears within weeks to months.
  • Skin. The disease can produce broad patches or, irregularly, round, faint pink or red areas on the skin (erythema marginatum). Lumps or nodules may occur beneath normal-appearing skin.

The goals of treatment for rheumatic fever are to relieve symptoms, destroy the group A streptococcus and prevent future infection.

Treatment of rheumatic fever involves :

  • Antibiotics to treat the streptococcal infection and prevent recurrences. Your doctor may prescribe penicillin or another antibiotic to eliminate any remaining strep bacteria in the body. Usually, additional antibiotics must be taken for several to many years to prevent additional attacks of rheumatic fever. Without continued antibiotic treatment, recurrence of rheumatic fever is common during the first three to five years after the initial infection.
  • Other medications to ease the symptoms of the disease. To reduce heart and joint inflammation, your doctor may recommend specific doses of over-the-counter or prescription nonsteroidal anti-inflammatory medication. For severe heart inflammation, a corticosteroid medication, such as prednisone, can reduce the inflammation.

The only known way to prevent rheumatic fever is to adequately treat strep throat infections with a full course of appropriate antibiotics.

Most of the time, a virus is the cause of a sore throat, and viruses don't lead to rheumatic fever. A sore throat with fever lasting more than 24 hours may indicate a strep infection. Only a small percentage of people with untreated strep throat will develop rheumatic fever. Prompt and complete treatment of strep throat with a full course of appropriate antibiotics can prevent strep throat from progressing to rheumatic fever.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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