Rheumatic Fever Explained: Symptoms, Treatment, and Prevention

Rheumatic fever is an inflammatory autoimmune disease that mostly affects children between the ages of 5 and 15 years. Joint pain, fever, and tiredness are some symptoms. It can damage the heart valves and cause chronic heart disease. Rheumatic fever is a potential complication of a contagious infection caused by certain Streptococcus bacteria. Rheumatic fever treatment can reduce inflammation and the risk of rheumatic heart disease.

Keep reading to learn about rheumatic fever, including symptoms, risk factors, and how physicians treat it.

Rheumatic fever is a unusual immune reaction to an infection caused by group A Streptococcus (GAS), typically S. pyogenes. This bacterium causes scarlet fever and strep throat.

It is unclear how the bacteria cause rheumatic fever. However, left untreated or improperly treated, a GAS infection has the potential to develop into acute rheumatic fever 1–5 weeks later, according to the Centers for Disease Control and Prevention (CDC). Rheumatic fever can cause serious health consequences, including heart problems and joint disease. 

Rheumatic fever is no longer prevalent in the United States, but it still causes rheumatic heart disease in millions of people worldwide. Experts estimate that 30 million people are living with rheumatic heart disease. The condition causes 305,000 deaths per year, according to the CDC and based on a 2016 Global Burden of Disease study. 

Learn about strep throat treatment here.

The symptoms of rheumatic fever may mimic other diseases like juvenile rheumatoid arthritis. Symptoms may include:

• fever
• painful joints, including pain that may move between joints 
• fatigue
• sore throat
• heart murmur
• uncontrolled, jerky body movements, also known as chorea 
• painless lumps near the joints, although this is rare
• rheumatic fever rash, which appears as nonitchy rings usually on the trunk, although a rash is rare 

When rheumatic fever affects the heart, additional symptoms may include: 

• shortness of breath
• weakness
• chest pain or discomfort
• rapid or irregular heart rate
• swollen abdomen due to retaining fluid 

If your child experiences shortness of breath or chest pain, call 911. 

If you or your child has the following strep throat symptoms, consider contacting a medical professional for treatment:  

• sudden sore throat
• pain with swallowing
• fever
• headache
• stomach ache, nausea, or vomiting

If your child has a sore throat or fever for more than 3 days or has a fever with a rash, contact their doctor straight away.

Learn more about the signs and symptoms of strep throat here.

The exact cause of rheumatic fever is not clear. Researchers know it is an autoimmune response to the GAS bacteria, but they do not know what causes the unusual response. They also know it is more likely to occur when these bacterial infections are not treated or treated improperly.

An autoimmune response is when the body’s natural defenses against foreign organisms cause harm to healthy tissues instead. This may cause inflammation and tissue damage. In rheumatic fever, this inflammation can affect the heart, joints, and central nervous system, among other organs. 

Rheumatic fever is not contagious, but GAS bacteria are highly contagious. When they infect the respiratory tract, the bacteria can spread easily from respiratory droplets when a person with the infection talks, coughs or sneezes, or through shared food or drinks.   

Rheumatic fever is associated with:

• untreated or insufficiently treated strep throat
• ages 5–15 years
• previous rheumatic fever

Learn how to prevent strep throat here.

Your doctor will conduct a physical exam and ask about your child’s specific symptoms and medical history — including a recent strep throat or another GAS infection. They may also perform a series of tests to diagnose rheumatic fever, since there is no single test for it. These tests may include:

• throat swab to detect a GAS infection
• blood test for antibodies to detect a recent GAS infection
• electrocardiogram to check the heart’s electrical activity
• echocardiogram to assess how the heart muscle and valves are working 
• chest X-ray

A physician will look for the presence of at least two major diagnostic criteria or one major and two minor criteria.

Major criteria include:

• heart inflammation
• arthritis in one or more joints
• chorea
• rash in which the center of the lesion appears unaffected
• nodules, or lumps under the skin

Minor criteria include:

• joint pain in one or more joints
• fever equal to or above 101.3°F (38.5°C)
• prolonged PR interval, an electrocardiogram finding associated with heart problems, with respect to age
• elevated inflammatory markers, such as erythrocyte sedimentation rate and C-reactive protein

Read up on C-reactive protein here.

The goal of rheumatic fever treatment is to reduce inflammation, eliminate remaining infection, manage symptoms, and prevent complications. Treatments may include:

• nonsteroidal anti-inflammatory drugs for pain and inflammation
• corticosteroids for inflammation
• heart medications
• surgery to repair damaged heart valves

The physician will prescribe penicillin or an equivalent antibiotic to clear any remaining strep bacteria. They may recommend long-term antibiotic treatment to reduce the chance of GAS infections and recurrent rheumatic fever with the associated risk of heart damage.

It is important to treat rheumatic fever early before it affects your child’s heart.

Prompt diagnosis — confirmed by a throat swab — and proper treatment of strep throat with antibiotics can help prevent rheumatic fever. It can also help prevent the spread of strep to other people. Here are some specific tips to consider:

• Start antibiotics within 9 days of the onset of a sore throat confirmed as strep throat.  
• Treat with penicillin to help prevent strep infections and recurrent rheumatic fever. 
• Practice hand hygiene, which includes washing your hands thoroughly and frequently.
• Disinfect frequently touched surfaces, since strep bacteria can survive on objects for some time. 
• If your child has strep throat, keep them home from school for 12 hours or more after taking antibiotics to ensure the infection is no longer contagious.

Learn about the dangers of untreated strep throat here.

One severe episode or recurrent episodes of rheumatic fever can damage the heart and cause chronic heart disease.

Acute rheumatic fever may cause carditis — inflammation of the heart — in up to 80% of cases. Carditis is associated with inflammation of the heart valves.

Heart valve damage that persists after rheumatic fever treatment is rheumatic heart disease. This may cause a backwards leak of blood through a valve when it closes. The medical term for this is “regurgitation.” This can further lead to such conditions as:

• heart failure
• stroke
• atrial fibrillation
• endocarditis

According to the CDC, carditis is the only complication of rheumatic fever that can be fatal or lead to long-term disability.

Below are some other questions that people ask about rheumatic fever.

No. The infection that causes rheumatic fever is contagious, but the fever itself is an immune response. 

Scarlet fever is a GAS infection that can cause a rash on the face and body, sore throat, and fever. You treat it with antibiotics. Left untreated, it can lead to rheumatic fever. 

Rheumatic fever is rare in adults but presents with the same symptoms as those in children.  

You may experience swollen joints, fever, fatigue, a sore throat, rash, uncontrolled body movements, and pain that moves between joints. Left untreated, rheumatic fever may cause rheumatic heart disease.  

There are currently no specific medications for acute rheumatic fever to reduce the progression to rheumatic heart disease. Healthcare professionals prescribe long-term antibiotic treatment to prevent recurrent rheumatic fever.  

The most common complication of rheumatic fever is rheumatic heart disease due to heart valve damage.

Rheumatic fever develops from untreated, or improperly treated GAS infections, like strep throat or scarlet fever. In some people, a GAS infection can cause an autoimmune condition with joint and potentially heart inflammation. Rheumatic fever mostly affects children between the ages of 5 and 15 years but can also affect young adults.  

Doctors treat rheumatic fever with medications to reduce inflammation and protect the heart from chronic disease.

Early diagnosis and treatment of GAS infections are key to preventing rheumatic fever or other complications. If you or your child has a sudden sore throat with a fever, contact your doctor for a strep test.

Prompt treatment with antibiotics will prevent the infection from spreading among family members and others in close contact and reduce the potential for rheumatic fever.