Rheumatic fever is a disease characterized by the inflammation of many connective tissues throughout the body, particularly in the heart, joints and central nervous system (the brain and spinal cord). The condition is the result of infection with Group A streptococcus bacteria, such as in strep throat or scarlet fever. It usually affects children between the ages of 6 and 15.

Rheumatic fever can cause fever, severe joint pain and fatigue. Although these symptoms are temporary, rheumatic fever can also damage the heart’s valves, chambers and vessels. Untreated, this damage can be permanent (rheumatic heart disease). There is also a high likelihood of rheumatic fever developing again, and people who develop rheumatic faver usually need to take prophylactic antibiotics for the rest of their life to avoid additional complications.

Rheumatic fever is a disease characterized by the inflammation of many connective tissues throughout the body, particularly in the heart, joints and central nervous system (the brain and spinal cord). Rheumatic fever is usually caused by an untreated infection with streptococcus bacteria, such as in  strep throat or scarlet fever.  

Rheumatic fever usually develops roughly 20 days after the streptococcus infection and can damage a wide variety of tissues in the body, especially the heart valves. It is one of the major causes of heart valve disease in the world. It can also damage the chambers and other vessels of the heart. Untreated, the damage to the heart will become permanent, at which point rheumatic fever is called rheumatic heart disease. Rheumatic heart disease may involve one or more of the following:

Rheumatic fever is more common in children aged from 6 to 15. Before the widespread availability of antibiotics in the United States, rheumatic fever was the most common cause of valve damage. However, cases of rheumatic fever are now relatively rare. According to the National Institutes of Health (NIH) roughly three percent of untreated streptococcus infections develop into rheumatic fever. 

The mortality rate for rheumatic heart disease varies greatly from country to country. In more developed countries, mortality is 0.5 per 100,000. In less developed countries, mortality reaches 8.2 per 100,000, accounting for millions of deaths globally every year. Much of these are due to the lack of antibiotics in developing countries and difficulties in diagnosing the disease.

Rheumatic fever is often caused by an untreated infection of strep throat, which causes a very sore throat and a fever of more than 100 degrees (37.8 degrees Celsius). Researchers estimate that about three percent of untreated cases of strep throat will develop into rheumatic fever.

The first symptoms of rheumatic fever tend to occur between one and six weeks after the initial infection, but some symptoms may not appear until six months later. Depending on the individual and the severity of the condition, these symptoms may include:

Signs of the condition that may be identified by a physician include:

• Carditis. Approximately 50 percent of patients with rheumatic fever exhibit this swelling of the heart walls. Damage to a valve and/or chordae, which attach the valve to the heart wall, will mostly affect the mitral valve or aortic valve.

• Chorea. Occurring in about 20 percent of cases, chorea is a rheumatic inflammation in the central nervous system. This condition, which can result in involuntary dance-like movements, may not begin until more than 90 days after the onset of the initial streptococcal infection.
  
  
• Lumps under the skin (subcutaneous nodules).

Most signs and symptoms are temporary and will disappear without any lasting problems. However, the heart is vulnerable to permanent damage from rheumatic fever.

There are no specific tests to diagnose rheumatic fever. Instead, physicians rely on observing any symptoms that may appear following an infection with streptococcus bacteria. Over time, a model has been developed to help guide physicians to diagnose rheumatic fever. A diagnosis can be made if a patient has two major manifestations, or one major and two minor manifestations.

The major manifestations include:

• Arthritis in the joints.
  
  
• Chorea. This describes inflammation of the central nervous system, resulting in involuntary dance-like movements.
  
  
• Rash.
  
  
• Lumps under the skin (subcutaneous nodules).

The minor manifestations include:

• Fever
• Joint pain
• Previous rheumatic fever or rheumatic heart disease

There is some evidence that a test for C-reactive protein (CRP) may also help physicians diagnose rheumatic fever. Because rheumatic fever is an inflammatory disease, blood levels of C-reactive protein are abnormal during the rheumatic process.

Medical intervention is critical to rid the body of the streptococcal infection. Penicillin therapy is the most commonly used and successful method for killing the infection, though other antibiotics may be used if a patient has an allergic reaction to penicillin. Penicillin is usually taken for at least ten days to treat the condition.

While the primary treatment is focused on killing the original infection, physicians will also attempt to relieve the symptoms of rheumatic fever. To relieve joint pain, the first step is plenty of bed rest to alleviate some of the pressure on the joints. As patients begin to heal, strenuous activity should be limited until they have fully recovered.

Anti-inflammatory medications are also commonly prescribed. These might include the following:

Heart replacement valve surgery may be necessary if serious degeneration of the valve structures occurs.

Once rheumatic fever has occurred, there is a strong likelihood that the event will recur. Preventive measures must then be taken to stop further damage. Continual antibiotic treatment is usually required. A common preventive program is long-acting penicillin administered every three to four weeks. Many researchers recommend this therapy in young patients until they are at least 18 years old.

Several conditions may develop as a result of rheumatic fever. These include:

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients or parents may wish to ask their doctor the following questions related to rheumatic fever:

1. Why do you think I have rheumatic fever?
   
   
2. What may have caused the condition?
   
   
3. What tests will you use to diagnose rheumatic fever?
   
   
4. Where will the tests be administered and how soon will I get the results?
   
   
5. What are my treatment options for the infection?
   
   
6. What can I take if I am allergic to penicillin?
   
   
7. When will I begin to see improvement after I have started treatment?
   
   
8. Are there any restrictions while I am being treated for rheumatic fever?
   
   
9. How can you determine if the rheumatic fever has damaged my heart?
   
   
10. What are the chances that my rheumatic fever will recur?
    
    
11. What can I do to  help prevent rheumatic fever in the future?
    
    
12. What should I do if I develop strep throat after I have rheumatic fever?
    
    
13. Can rheumatic heart disease be treated?
    
    
14. How will rheumatic fever affect me or my fetus during pregnancy?