Rheumatic fever is a serious inflammatory condition that can develop after an untreated or inadequately treated streptococcal throat infection. It can affect many parts of the body, including the heart, joints, skin, and brain. Understanding its causes, symptoms—especially the characteristic rash—and treatment options is essential for timely diagnosis and prevention of long-term complications.
What Is Rheumatic Fever?
Rheumatic fever is an autoimmune disease that occurs as a delayed complication of a group A Streptococcus (GAS) throat infection, commonly known as strep throat. The body’s immune response mistakenly attacks its own tissues, leading to widespread inflammation.
Although rare in developed countries due to widespread antibiotic use, rheumatic fever remains a significant health concern in developing regions.
Causes of Rheumatic Fever
Group A Streptococcal Infection
The primary cause of rheumatic fever is an untreated or poorly treated infection by group A Streptococcus bacteria. These bacteria are responsible for:
- Strep throat
- Scarlet fever
When strep infections are left untreated, the immune system’s response can become misdirected, attacking healthy tissues such as the heart, joints, skin, and brain.
Immune System Reaction
Rheumatic fever is not a direct bacterial infection. Instead, it results from an abnormal immune reaction where antibodies intended to fight the bacteria mistakenly target the body’s own tissues, leading to widespread inflammation.
Risk Factors
Certain factors increase the risk of developing rheumatic fever, including:
Age: Most common between ages 5 and 15
Geography: More prevalent in developing countries with limited access to medical care
Family history: Genetic predisposition may increase susceptibility
Socioeconomic conditions: Overcrowded living environments can promote the spread of streptococcal infections
Symptoms of Rheumatic Fever
Symptoms typically appear 2 to 4 weeks after a strep throat infection. They can vary widely but often include several characteristic signs.
Major Symptoms
Carditis (Heart Inflammation)
Carditis is one of the most serious manifestations and may affect:
- Heart valves (leading to rheumatic heart disease)
- Heart lining (endocardium)
- Heart muscle (myocardium)
Signs include chest pain, shortness of breath, and heart murmurs.
Arthritis
Painful, swollen joints are common. The arthritis:
- Often migrates from one joint to another
- Commonly affects larger joints such as knees, ankles, elbows, and wrists
Sydenham’s Chorea
This is a neurological disorder causing:
- Involuntary, jerky movements
- Emotional instability
- Muscle weakness
It occurs due to inflammation in parts of the brain.
Erythema Marginatum (Characteristic Rash)
One of the hallmark symptoms is a distinctive rash called erythema marginatum, which:
- Appears as pink or red, ring-shaped patches
- Has a clear center and slightly raised edges
- Primarily affects the trunk and limbs
- Is non-itchy and may come and go
Subcutaneous Nodules
Small, painless lumps may form under the skin near joints, particularly over bones or tendons.
Minor Symptoms
- Fever
- Fatigue
- Weight loss
- Shortness of breath
- Rapid heart rate (even when resting)
Long-Term Complications
Without proper treatment, rheumatic fever can cause permanent damage to the heart valves, leading to rheumatic heart disease, which may require lifelong management or surgery.
Diagnosis of Rheumatic Fever
Medical History and Physical Examination
Doctors often base their diagnosis on:
- Recent history of strep throat
- Clinical symptoms
The Jones Criteria, a set of guidelines that include major and minor symptoms along with evidence of a preceding streptococcal infection, are commonly used.
Laboratory Tests
Throat culture or rapid antigen test: To confirm a current strep infection
Blood tests: Checking for inflammatory markers like ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein)
Antistreptolysin O (ASO) titer: Detects antibodies produced against strep bacteria
Imaging Tests
Echocardiogram: To assess heart function and detect valve damage
Electrocardiogram (ECG): To detect heart inflammation or rhythm abnormalities
Treatment for Rheumatic Fever
Prompt treatment is crucial to reduce inflammation, control symptoms, and prevent permanent damage.
Antibiotics
The first step is to eliminate any residual group A streptococcal bacteria:
- Penicillin is commonly used
- In cases of penicillin allergy, alternatives like azithromycin may be prescribed
Long-term antibiotic prophylaxis may be required for several years to prevent recurrence.
Anti-inflammatory Medications
To reduce inflammation and relieve symptoms:
- Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain and fever
- Corticosteroids for severe carditis or when NSAIDs are insufficient
Supportive Care
- Bed rest during the acute phase
- Monitoring of cardiac function
- Treatment for chorea may include medications like valproic acid or corticosteroids
Prevention of Rheumatic Fever
Prompt Treatment of Strep Throat
The best way to prevent rheumatic fever is to:
- Recognize and treat strep throat early with appropriate antibiotics
- Encourage completion of the full antibiotic course even if symptoms improve
Public Health Measures
In regions where rheumatic fever is common, public health efforts focus on:
- Improving access to healthcare
- Reducing overcrowding
- Promoting hygiene practices
Living with Rheumatic Fever
Long-Term Management
Patients with a history of rheumatic fever often require:
- Regular cardiology checkups
- Long-term antibiotic prophylaxis to prevent recurrent infections
- Lifestyle adjustments to reduce heart strain
Emotional and Psychological Support
Because rheumatic fever can impact quality of life, emotional and psychological support for patients—especially children and adolescents—is crucial.
Final Thoughts
Rheumatic fever is a serious but preventable condition that stems from untreated streptococcal infections. Recognizing early symptoms, such as a distinctive rash and joint pain, along with seeking prompt medical care, is vital to avoiding severe complications like rheumatic heart disease.
With timely treatment and proper management, most individuals can recover fully and live healthy lives. Education about the importance of treating strep throat and improving public health systems can significantly reduce the burden of this disease worldwide.
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