Rheumatic fever awareness

Overview

Rheumatic fever is an inflammatory condition that can develop after a bacterial throat infection (strep throat) is not treated properly. It happens when the body's immune system mistakenly attacks its own tissues, especially the heart, joints, skin, and brain.

No, rheumatic fever is not common in places like the UK and other developed countries, but it still affects many people in developing regions where strep throat may not be treated quickly.

It mostly affects children and teenagers, especially those who have had a recent strep throat infection that was not fully treated with antibiotics. Adults can also get it, but it is less common.

Symptoms

Common symptoms

• Fever
• Painful, swollen joints (usually knees, ankles, elbows, and wrists)
• Chest pain or shortness of breath
• Feeling very tired
• A pink rash with wavy edges (called erythema marginatum)
• Small, firm bumps under the skin (subcutaneous nodules)

Symptoms in children

• All the common symptoms, plus jerky, uncontrollable movements of the face, hands, or feet (called Sydenham chorea or St. Vitus' dance)
• They may also seem emotional or irritable

Symptoms in older adults

• Joint pain and swelling may be more severe
• Heart inflammation (carditis) can be more common and cause chest pain, shortness of breath, or swelling in the legs

Causes

Main causes

• An infection with group A Streptococcus bacteria (strep throat or scarlet fever) that was not treated or not treated enough with antibiotics.
• The body's immune system overreacts to the bacteria and attacks its own healthy tissues, causing inflammation.

Risk factors

• Living in crowded or poor conditions where strep infections spread easily
• Limited access to healthcare or not finishing antibiotics for a sore throat
• Having had rheumatic fever before
• Family history of rheumatic fever

When to see a doctor

See a doctor urgently if:

• If you or your child has a fever and painful, swollen joints, especially after a sore throat in the past few weeks
• If you have chest pain, shortness of breath, or notice a new rash or lumps under the skin

Book a routine appointment if:

• If your child had a strep throat and the symptoms were not fully treated, see a doctor to check for signs of rheumatic fever, even if your child feels better

Diagnosis

Your doctor will ask about your symptoms and any recent sore throat or scarlet fever. They will do a physical exam to look for signs of inflammation in the heart, joints, skin, and brain. There is no single test; diagnosis is based on a combination of findings.

Tests that may be done

• Throat swab to check for strep bacteria (if still present)
• Blood tests (like ESR, CRP, and ASO titre) to look for signs of inflammation or past strep infection
• Electrocardiogram (ECG) to check the heart's rhythm
• Echocardiogram (ultrasound of the heart) to see if the heart valves are damaged

What to expect at your appointment

The doctor will ask about your recent health and examine you. You may need blood tests and heart tests. The process can take time because symptoms can be similar to other conditions. A specialist, such as a cardiologist, may be involved.

Treatment

Treatment aims to clear any remaining strep bacteria, reduce inflammation, and prevent damage to the heart. It involves antibiotics and medicines to control inflammation. Most people recover fully with early and proper treatment.

Self-care at home

• Get plenty of rest to help your body fight the inflammation.
• Drink fluids to stay hydrated.
• Avoid heavy physical activity until your symptoms go away.
• Take all prescribed medicines exactly as your doctor tells you.

Medical treatments

Doctors prescribe antibiotics (usually penicillin or a similar type) to kill any remaining strep bacteria. Anti-inflammatory medicines (such as aspirin or ibuprofen) help reduce fever and joint pain, but they must be taken only under a doctor’s supervision. In cases of severe heart inflammation, steroids may be given to bring down swelling.

When is surgery considered?

If rheumatic fever causes permanent damage to the heart valves (rheumatic heart disease), surgery may be needed years later to repair or replace the damaged valve. This is not common, but it is sometimes necessary.

Living with this condition

After recovery, you or your child may need regular check-ups with a heart specialist if the heart was affected. It is important to take any long-term antibiotics as prescribed to prevent a recurrence. Watch for new symptoms and tell your doctor right away if they return.

Lifestyle tips

• Practice good hygiene, like washing hands often, to avoid infections.
• Complete all antibiotics for any future strep infections.
• Take good care of your teeth and gums to prevent infections that could affect the heart.

Diet and exercise

No special diet is needed, but eating a balanced diet with plenty of fruits and vegetables helps your overall health. Once you feel better, gentle exercise is safe, but talk to your doctor if you have heart damage. They may advise avoiding very strenuous sports.

Mental health and emotional wellbeing

Dealing with a serious illness can be stressful and worrying, especially if it affects the heart. It is normal to feel anxious or sad. Talk to your family, friends, or a mental health professional. Your doctor can also suggest ways to cope.

Prevention

Yes, rheumatic fever can be prevented by treating strep throat quickly and completely with antibiotics. If you or your child has a sore throat with fever, see a doctor. People who have already had rheumatic fever may need to take low-dose antibiotics for many years to prevent it from coming back.

Vaccines

There is no vaccine to prevent strep throat or rheumatic fever. However, staying up to date with other vaccines (like flu and COVID-19) helps keep your immune system strong and reduces the chance of infections.

Screening programmes

There is no routine screening for rheumatic fever. If you have a family history or live in an area where it is common, talk to your doctor about whether you or your child should be checked after a sore throat.

Complications

If left untreated

• Rheumatic heart disease (permanent damage to heart valves)
• Heart failure (the heart cannot pump blood well)
• Stroke (if a blood clot travels to the brain)
• Infection of the damaged heart valves (infective endocarditis)

Long-term outlook

With early treatment, most people recover fully from an episode of rheumatic fever. The risk of heart damage is much lower when the fever is treated promptly. If heart valves are affected, many people live normal lives with regular medical care and sometimes surgery. Continued follow-up and preventive antibiotics can keep the condition from getting worse.

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