Rheumatic Fever

In this factsheet:
• The Facts on Rheumatic Fever
• Causes of Rheumatic Fever
• Symptoms and Complications of Rheumatic Fever
• Diagnosing Rheumatic Fever
• Treating and Preventing Rheumatic Fever

The Facts on Rheumatic Fever

Rheumatic fever was once a common cause of heart problems in childhood. In North America, it's become very rare in the age of antibiotics. When it does strike, however, it can still have serious consequences for heart health.

Rheumatic fever is more common in girls than in boys. It sometimes strikes adults, though there are no reliable figures on adult rates. Rheumatic fever remains a serious childhood health problem in many developing countries.

Causes of Rheumatic Fever

Rheumatic fever is caused by a combination of bacterial infection and immune system overreaction. It almost always follows a strep throat infection, that is, infection of the respiratory tract by bacteria of the Streptococcus family. Strep throat infections themselves occur most often in people who already have a viral infection like a cold or the flu. Children are far more likely to get strep throat than adults.

Normally, Streptococcus causes a cough and a sore throat, and clears up with antibiotics. In a few cases, however, children with strep throat begin complaining of pain in the joints or other unusual symptoms. This usually happens one to three weeks after the streptococcal infection (which may have already settled).

The disease has an affinity for the joints, the central nervous system (brain and spinal cord), and the heart. In the heart, the disease can affect the inner lining of the heart including the heart valves (endocarditis), the muscle of the hear (myocarditis), or the covering of the heart (percarditis).

In some people, the body reacts with a massive immune system reaction to the affected areas. The cells that normally kill invading bacteria become so active that they also attack the affected tissues. The result in the joints is temporary arthritis (inflammation of the joints). In the heart, it can permanently damage crucial heart valves, increasing the risk of heart problems later in life. Rheumatic fever can also cause problems, which are usually reversible, with the nervous system.

Symptoms and Complications of Rheumatic Fever

The symptoms of rheumatic fever depend on whether the heart, joints, or nervous system are most affected. Most people with rheumatic fever have a fever and joint pain. The joint pain usually affects large joints such as the knees, elbows, ankles, or wrists, and the pain characteristically migrates from one joint to another, so that one or more joints may be swollen, red, and extremely tender. The arthritis is usually reversible.

Many people who develop rheumatic fever suffer damage to their heart valves (endocarditis, most commonly mitral stenosis), to the heart muscle (myocarditis), to the sac covering the heart (pericarditis), or all three at once. This may cause no symptoms, but some people feel heart palpitations or chest pain. Very occasionally, there is heart failure, though few people in North America die during a rheumatic fever infection.

In severe cases, the valves have to be replaced with artificial ones. People with damaged valves and those with an artificial heart valve are at increased risk of a heart infection later in life (infectious endocarditis).

If the process of infection and inflammation affects the central nervous system, it may produce a symptom known as chorea. This affects about 10% of people with rheumatic fever. It's most likely in children aged 7 to 14 years, especially girls, and almost never occurs after puberty. The onset of chorea is usually gradual, and it often first appears several months after the rheumatic fever has passed. Teachers may be the first to notice it and mistake it for clumsiness or restlessness. Symptoms may include:

• grimacing
• purposeless movements of the arms and legs
• indistinct speech

Occasionally, chorea is the only visible symptom of rheumatic fever. There may also be a rash or pea-sized lumps under the skin.

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