Rheumatic Fever

Overview

Rheumatic fever is a rare but serious condition that can develop after an infection caused by strep bacteria, such as strep throat or scarlet fever. It happens when the body’s immune system mistakenly attacks healthy tissues, especially the heart, joints, skin, and brain. If not treated properly, it can cause lasting damage to the heart valves.

Rheumatic fever has become rare in the United Kingdom and other wealthy countries due to better living conditions and early treatment of infections. It is still common in low- and middle-income countries, especially where access to healthcare is limited.

It most often affects children and teenagers between the ages of 5 and 15, but it can occur at any age. In the UK, it is very rare because antibiotics are widely used to treat strep infections. However, repeated strep infections increase the risk.

Symptoms

Common symptoms

• Fever and feeling generally unwell
• Painful, swollen joints — often in the knees, ankles, elbows, or wrists
• Chest pain or a fast heartbeat
• A distinctive pink rash with ring-like patterns, usually on the chest, arms, or torso
• Small, painless lumps under the skin (called nodules)
• Unusual jerky movements of the hands or face (called chorea)

Symptoms in children

• In children, rheumatic fever can cause the same symptoms, but they may be more likely to have uncontrolled movements (Sydenham chorea), also called St. Vitus dance.
• Children often complain of pain in many joints that moves from one joint to another.
• A high fever and a rash with rings may be the first signs.

Symptoms in older adults

• Older adults who get rheumatic fever may not have the typical joint pain or rash.
• They may instead experience breathlessness, chest discomfort, or symptoms of heart failure due to valve damage.
• Rheumatic fever is very uncommon in adults in the UK, so doctors may consider other causes first.

Causes

Main causes

• An infection with group A streptococcus bacteria (strep throat or scarlet fever) that is not fully treated
• The body’s immune response mistakenly attacking its own tissues, especially the heart valves
• Repeated strep infections, which can increase the risk of rheumatic fever

Risk factors

• Age between 5 and 15 years
• Living in crowded conditions, such as large families or shared dormitories
• Lack of access to healthcare and antibiotics
• Previously having rheumatic fever, which makes another episode more likely if you get strep again
• Family history of rheumatic fever

When to see a doctor

See a doctor urgently if:

• If you or your child has a sore throat with a fever, especially if there is also a rash or difficulty swallowing, see a doctor within 24 hours.
• If you have swollen, painful joints or a new heart murmur, seek medical attention promptly.
• If you notice any emergency symptoms, call your local emergency number immediately.

Book a routine appointment if:

• If you have had rheumatic fever before, you should have regular check-ups with your doctor, including heart checks.
• If you have had a strep infection and feel more tired or short of breath than usual, make a routine appointment.

Diagnosis

Your doctor will ask about your medical history, examine you, and look for signs of a recent strep infection. They may use a set of guidelines called the Jones criteria, which help doctors decide whether symptoms are likely to be rheumatic fever.

Tests that may be done

• A throat swab to test for strep bacteria
• Blood tests to look for antibodies against strep (ASO and anti-DNAse B)
• Blood tests to check for inflammation (such as erythrocyte sedimentation rate and C-reactive protein)
• An electrocardiogram (ECG) to check the heart’s rhythm
• An echocardiogram (ultrasound of the heart) to look at the heart valves

What to expect at your appointment

If your doctor suspects rheumatic fever, you may be referred to a specialist (paediatrician or cardiologist). It can take several weeks to confirm the diagnosis because symptoms may develop gradually. Most of the tests are safe and painless.

Treatment

Treatment is aimed at clearing the strep infection, reducing inflammation, preventing further damage to the heart, and relieving symptoms. You will likely need a course of antibiotics to treat the infection. You may also need anti-inflammatory medicines to reduce swelling and pain. If your heart is affected, you may need additional medicines to help it work more easily.

Self-care at home

• Get plenty of rest and sleep during the acute phase.
• Use a cool compress on swollen joints to ease discomfort.
• Ask your pharmacist or doctor about safe pain relief options.
• Drink plenty of fluids to stay hydrated.

Medical treatments

Your doctor will usually prescribe a course of antibiotics to clear the strep infection. You will also be given anti-inflammatory medicines to reduce swelling and pain. If your heart is affected, you may need medicines to help your heart pump more effectively. After the first episode, you will likely need to take regular preventive antibiotics to stop another infection. Always follow your doctor’s advice on medicines and never stop taking them without discussion.

When is surgery considered?

If rheumatic fever has caused severe damage to heart valves, you may need surgery to repair or replace a valve. This is not common in the UK and is usually only needed after serious damage occurs.

Living with this condition

After a bout of rheumatic fever, you will need regular check-ups with a cardiologist to watch your heart. Daily life may need to be slower for a few weeks or months, and you may need to limit physical activity until your doctor says it is safe. Taking prescribed medicines exactly as told is very important.

Lifestyle tips

• Keep up good hand hygiene to avoid infections.
• Avoid close contact with people who have sore throats or scarlet fever.
• If you have had rheumatic fever, tell any doctor or dentist before treatment — they may prescribe antibiotics to prevent infection on the heart valves.
• Attend all follow-up appointments.

Diet and exercise

Eating a balanced diet and getting gentle exercise helps recovery. Avoid strenuous exercise while your heart is still inflamed. Ask your doctor when it is safe to return to sports and activities.

Mental health and emotional wellbeing

Living with a condition that affects your heart can cause anxiety, stress, or low mood. It is normal to feel worried, especially after a hospital stay. Talk to your healthcare team about how you feel. They can offer support or refer you to a counsellor. In an emergency, you can always call your local mental health crisis line.

Prevention

Yes. Treating strep throat quickly and completely with antibiotics can prevent most cases of rheumatic fever. Good hygiene — including washing hands and not sharing cups or utensils — also helps stop the spread of strep bacteria. If you have already had rheumatic fever, regular preventive antibiotics (long-term) can stop it from coming back.

Vaccines

There is no vaccine to prevent rheumatic fever. However, keeping up to date with regular vaccinations, such as the flu vaccine, can help reduce the risk of other infections.

Screening programmes

Screening is not routinely recommended for healthy people. Doctors may recommend a heart examination (echocardiogram) for people who have had rheumatic fever, to check for valve damage.

Complications

If left untreated

• Rheumatic heart disease — permanent damage to one or more of the heart valves
• Heart failure — where the heart cannot pump blood effectively
• Atrial fibrillation — an irregular heart rhythm
• Infective endocarditis — a serious heart valve infection
• Stroke — if a piece of a damaged valve travels to the brain

Long-term outlook

With prompt treatment, many people recover from rheumatic fever without lasting damage. If heart valves are affected, you can still live a full, active life with regular care and support. Medicines and, occasionally, surgery can help manage complications. The earlier it is caught, the better the long-term outlook.

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