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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia [Internet].

Rheumatic fever

Acute rheumatic fever

Last reviewed: May 30, 2012.

Rheumatic fever is an inflammatory disease that may develop after an infection with group A Streptococcus bacteria (such as strep throat or scarlet fever). The disease can affect the heart, joints, skin, and brain.

Causes, incidence, and risk factors

Rheumatic fever is common worldwide and is responsible for many cases of damaged heart valves. It is not common in the United States, and usually occurs in isolated outbreaks. The latest outbreak was in the 1980s.

Rheumatic fever mainly affects children ages 5 -15, and occurs approximately 14-28 days after strep throat or scarlet fever.

Symptoms

  • Abdominal pain
  • Heart (cardiac) problems, which may not have symptoms, or may result in shortness of breath and chest pain
  • Joint pain, arthritis (mainly in the knees, elbows, ankles, and wrists)
  • Joint swelling; redness or warmth
  • Nosebleeds (epistaxis)
  • Skin nodules
  • Skin rash (erythema marginatum)
    • Skin eruption on the trunk and upper part of the arms or legs
    • Eruptions that look ring-shaped or snake-like
  • Sydenham chorea (emotional instability, muscle weakness and quick, uncoordinated jerky movements that mainly affect the face, feet, and hands)

Signs and tests

Your doctor or nurse will examine you. This will include carefully checking your heart sounds, skin, and joints.

Tests may include:

Several major and minor criteria have been developed to help standardize rheumatic fever diagnosis. Meeting these criteria, as well as having evidence of a recent streptococcal infection, can help confirm that you have rheumatic fever.

The major criteria for diagnosis include:

The minor criteria include:

  • High ESR
  • Joint pain
  • Abnormal EKG

You'll likely be diagnosed with rheumatic fever if you meet two major criteria, or one major and two minor criteria, and have signs that you've had a previous strep infection.

Treatment

If you are diagnosed with acute rheumatic fever you will be treated with antibiotics.

Anti-inflammatory medications such as aspirin or corticosteroids reduce inflammation to help manage acute rheumatic fever.

You may have to take low doses of antibiotics (such as penicillin, sulfadiazine, or erythromycin) over the long term to prevent strep throat from returning.

Expectations (prognosis)

If rheumatic fever returns, your doctor may recommend you take low-dose antibiotics continually, especially during the first 3 -5 years after the first episode of the disease. Heart complications may be severe, particularly if the heart valves are involved.

Complications

Calling your health care provider

Call your health care provider if you develop symptoms of rheumatic fever. Because several other conditions have similar symptoms, you will need careful medical evaluation.

If you have symptoms of strep throat, tell your health care provider. You will need to be evaluated and treated if you do have strep throat, to decrease your risk of developing rheumatic fever.

Prevention

The most important way to prevent rheumatic fever is by getting quick treatment for strep throat and scarlet fever.

References

  1. Low DE. Nonpneumococcal streptococcal infections, rheumatic fever. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 298.

Review Date: 5/30/2012.

Reviewed by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Penicillin reduces the risk of streptococcal throat infections and attacks of rheumatic fever in people who have already had a bout of rheumatic feverPenicillin reduces the risk of streptococcal throat infections and attacks of rheumatic fever in people who have already had a bout of rheumatic fever
    Rheumatic fever is a rare complication of throat infection, that can damage the heart. People who have had rheumatic fever can suffer from it again following streptococcal throat infection if they do not receive regular penicillin. Penicillin for prevention can be given by injection or as tablets. Taking tablets is easier but might not work as well as injections. The review of trials compared different ways of giving penicillin. Penicillin seemed to work better as injections than as tablets. Injections given every two or three weeks worked better than when given every four weeks. However, more research is needed.
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