Rheumatic Fever

Rheumatic fever is an inflammatory disease which can affect the brain, skin, joints and heart. It is an uncommon complication of untreated group A streptococci bacterial infections of the throat or skin. 1 2

A high fever, sore joints, chest pain and tiredness can all be symptoms of rheumatic fever. Usually, these symptoms will resolve spontaneously, however, there is a risk of long-term damage to the heart, a condition known as rheumatic heart disease. 3

The best way to prevent rheumatic fever is to prevent certain bacterial infections or by treating them promptly with antibiotics.

Rheumatic fever is the result of a faulty reaction of the body’s immune system to certain types of bacteria. This causes it to attack healthy tissues along with the infection, causing damage to the body. 1 

The symptoms experienced by someone with rheumatic fever are the result of inflammation caused by the immune system. Most commonly affected parts of the body include the skin, joints and heart. 1 2 3

Rheumatic fever may develop from untreated throat or skin infections, specifically those caused by a type of bacteria called group A Streptococcus. 1 

Infections which can develop into rheumatic fever include:

• strep throat
• scarlet fever
• impetigo

Not everyone with these conditions will get rheumatic fever, but it is still important to treat them with antibiotics in order to reduce the risk.

Scarlet fever is a pink, bumpy rash which may develop as a result of a group A streptococci infection in the throat or on the skin. Doctors will treat scarlet fever with antibiotics and it rarely causes any complications. Scarlet fever which has not been successfully treated may develop into rheumatic fever, which can be more serious. 4

Symptoms usually appear 1 to 5 weeks after a bacterial throat infection. The most common rheumatic fever symptoms are:

• fever
• joint pain
• chest pain
• uncontrollable movements, such as jerking, in the hands, feet and face
• feeling short of breath
• fatigue
• small lumps under the skin

Rarely, people with rheumatic fever may get a rash, which appears as pale pink rings. 1 2 3

There is no single test for rheumatic fever. A doctor may ask you questions about your health and perform an examination to reach a rheumatic fever diagnosis. Often, a throat swab will be taken to check what bacteria is causing the infection. 1 5

After that, further investigations may be done to see what organs are affected. Common investigations include an echocardiogram or electrocardiogram (ECG) to look for any damage to the heart. It may be necessary to have blood tests done, to confirm if there are signs of infection or inflammation in the body. 1

Rheumatic fever treatment focuses on treating the underlying bacterial infection with a course of antibiotics. It is important that these are taken correctly to reduce the chance of the infection returning. 6 It may be necessary to take antibiotics for several years to prevent rheumatic fever coming back. Most people recover within about 3 months, but this can vary depending on the severity. 2

Rheumatic fever symptoms are treated with a variety of medicines. These may include:

• painkillers to ease chest or joint pain
• steroid injections
• medication to prevent uncontrolled movements
• anti-inflammatory medications

If rheumatic fever leads to long term effects, life-long medication may be needed to support heart function. 2

Rheumatic fever is known as an autoimmune disease. This means that the body’s immune system damages its own tissues and cells when fighting unwanted pathogens. Long term effects of rheumatic fever include damage to organs, especially the heart. 1

Rheumatic fever can cause permanent damage to heart valves and muscle, which can cause heart failure. Symptoms may not be noticed for several years and commonly include irregular heartbeats, chest pain and breathlessness. 7

There is no cure for rheumatic heart disease, but medications can help the symptoms. In some cases, surgery to replace heart valves may be recommended. 7

Rheumatic fever mostly affects children and young adults under the age of 30.[^8] It is becoming increasingly less common in countries with developed health care systems, due to the availability of antibiotics to treat throat and skin infections. 

Higher risk groups include those living in areas of poverty, overcrowding or where access to healthcare is limited. 7

The best way to prevent rheumatic fever is to avoid getting group A streptococci infections. This can be done by improving general hygiene, such as washing hands and reducing overcrowding. If infection does occur, prompt antibiotic treatment can stop the progression into rheumatic fever. 7

Q: How does rheumatic fever affect the heart?

A: Rheumatic fever causes an autoimmune response, which means the body’s immune system attacks its own organs, including heart valves. This can cause long-term damage to the heart, a condition known as rheumatic heart disease.

Q: How common is rheumatic fever?

A: Rheumatic fever has become rare in countries where streptococcal infections are treated promptly with antibiotics. However, even in cases where the infection remains untreated, only a small percentage of those will go on to develop rheumatic fever. 

Q: How is rheumatic fever diagnosed?

A: In order to diagnose Rheumatic fever, your doctor may ask you about your past medical history and your symptoms. Often, further investigations are done to confirm a diagnosis or to see how the disease is affecting your body, especially the heart. 

Q: How long does rheumatic fever last?

A: With treatment, most people go on to make a full recovery after 1-3 months. If complications arise, you may need follow-up treatments and check-ups for a number of years to spot the long-term effects of rheumatic fever.