16616 Rheumatic Fever

Overview

Rheumatic fever is an illness that can sometimes develop a few weeks after a throat infection caused by a specific type of bacteria called Group A Streptococcus. It happens when the body's immune system gets confused and mistakenly attacks its own healthy tissues, especially in the joints, skin, brain, and heart.

Rheumatic fever is now rare in many high-income countries, but it still occurs in some parts of the world and in communities where access to healthcare is limited.

It most often affects children and teenagers between the ages of 5 and 15, although it can also occur in adults.

Symptoms

Common symptoms

• Fever
• Painful, swollen joints – usually the knees, ankles, elbows, or wrists
• Chest pain or an uncomfortable awareness of the heartbeat (palpitations)
• Shortness of breath
• A flat, sometimes blotchy pink rash on the chest, back, or abdomen
• Small lumps under the skin, often over joints or along the spine
• Jerky, uncontrolled movements in the hands, feet, or face (called chorea or Sydenham chorea)

Symptoms in children

• Children may complain of tiredness, sore joints, or simply not want to move around much.
• They may show unusual emotional swings, clumsiness, or difficulty concentrating if the nervous system is involved.
• In some children, the rash or joint swelling is not obvious, so it is important to mention any recent sore throat.

Symptoms in older adults

• Older adults may notice more joint pain and stiffness, which can be confused with arthritis.
• They may also experience more heart-related symptoms, such as breathlessness, chest discomfort, and swelling in the ankles or feet.
• Symptoms can come on gradually, so it is important to see a doctor for proper evaluation.

Causes

Main causes

• A recent infection with Group A Streptococcus bacteria – usually a throat infection (strep throat) or scarlet fever.
• An immune system reaction that mistakenly attacks the body's own tissues, especially the heart, joints, skin, and brain.

Risk factors

• Not treating a suspected strep throat infection with antibiotics
• Being a child or teenager, especially between ages 5 and 15
• Living in crowded conditions or in places where medical care is hard to access
• Having had rheumatic fever before
• A family history of rheumatic fever

When to see a doctor

See a doctor urgently if:

• See a doctor as soon as possible if you or your child has a sore throat and a fever, especially with a headache, tummy pain, or a red rash. Early treatment of strep throat is the best way to prevent rheumatic fever.

Book a routine appointment if:

• If you have had a sore throat and then develop joint pain, a rash, breathlessness, or unusual movements a few weeks later, ask your doctor for an appointment even if you feel okay.

Diagnosis

Your doctor will listen to your story, examine you, and look for signs of inflammation. There is no single test, so they will use a combination of clues and tests.

Tests that may be done

• A throat swab – a simple cotton tip to wipe the back of the throat – to look for strep bacteria, though it may be negative if the infection happened weeks before
• Blood tests to look for markers of inflammation and immune responses
• An ECG (a quick test that records the heart's electrical activity)
• An echocardiogram (an ultrasound scan of the heart) to check the heart valves
• Sometimes a chest X-ray to see if the heart is enlarged or the lungs are affected

What to expect at your appointment

If rheumatic fever is suspected, you or your child will usually be referred to a specialist doctor – often a cardiologist or rheumatologist – for more detailed assessment. This often happens in hospital, especially if the heart is involved.

Treatment

Treatment aims to remove the original strep bacteria, reduce inflammation and symptoms, and prevent future attacks. Most people improve with prompt medical care.

Self-care at home

• Rest as much as possible while joints are painful or you are feeling unwell
• Use over-the-counter pain relievers only as advised by your doctor or pharmacist
• Keep warm and comfortable
• Drink plenty of fluids unless a doctor says otherwise
• Avoid physical activity, especially sports, while your joints are swollen or if your heart is affected

Medical treatments

Treatment usually starts with a full course of antibiotics to clear the strep bacteria from your throat. Anti-inflammatory medicines are given to reduce joint pain, fever, and swelling. If a fever or heart inflammation is severe, treatment may happen in a hospital, possibly with steroid medicines. In people at risk of further attacks, long-term antibiotics may be prescribed for months or years to prevent another rheumatic fever. This is usually discussed and reviewed by a specialist.

When is surgery considered?

In rare cases, if rheumatic fever damages a heart valve severely, surgery may be needed months or years later to repair or replace the valve. This is a long-term decision and is not part of the first treatment.

Living with this condition

After the initial acute illness, most children and adults take a few weeks to feel back to normal. Follow-up appointments are important, especially to check the heart. Some people need to take daily antibiotics for many years to prevent a recurrence.

Lifestyle tips

• Keep up with regular hand washing and avoid close contact with anyone who has a sore throat
• Maintain good dental hygiene – healthy teeth and gums reduce the chance of infections
• If you have been prescribed long-term antibiotics, take them exactly as directed
• Let your family, school, or workplace know about your condition so they can support you

Diet and exercise

Eat a healthy, balanced diet with fruits, vegetables, and whole grains. Gentle activity can be gradually increased once your doctor confirms your heart is stable. Competitive or strenuous exercise may need to be limited, especially if the heart valves are affected – always follow your doctor's advice.

Mental health and emotional wellbeing

Living with a condition that can affect your heart can be worrying. It is normal to feel anxious, frustrated, or low. Talking to your healthcare team, family, or close friends can help. If emotional difficulties persist, ask a doctor about mental health support.

Prevention

Yes, in most cases. The most important step is to get a sore throat checked if you suspect strep throat, and if prescribed antibiotics, finish the full course. Good hygiene, such as regular hand washing, also reduces the spread of strep bacteria.

Vaccines

There is no vaccine specifically for rheumatic fever or strep throat. Keeping up to date with other recommended vaccines can help you avoid infections that weaken your immune system, but they do not prevent rheumatic fever directly.

Screening programmes

Routine screening for rheumatic fever is not common in most places. However, in communities where rheumatic fever is more common, your doctor may recommend tests after a known strep infection to catch early signs.

Complications

If left untreated

• Heart valve damage (rheumatic heart disease), which can lead to heart failure
• Recurrent attacks that cause more damage over time
• Inflammation of the heart muscle (myocarditis) or the sac around the heart (pericarditis)
• Stroke, especially if a damaged heart valve increases the risk of a clot
• Long-term disability from severe joint damage – though this is less common

Long-term outlook

With early recognition and modern treatment, most people with rheumatic fever recover fully. When it is detected early, heart damage can be limited. Even if the heart is affected, lifelong management is possible with regular check-ups and preventive care. Most people can live a full, active life.

Find support

International organisations

• World Health Organization ↗

Local organisations

• NHS ↗ · United Kingdom

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.