Alternate Names: Adult rheumatic fever; Juvenile rheumatic fever

Causes and Risks: Rheumatic fever is caused by recent (usually within 1 to 5 weeks) infection with streptococcus bacteria, such as may occur with strep throat and scarlet fever. It is uncommon in the U.S. except in people who have had untreated strep infections. It may occur in adults or children but is most common in children 5 to 15 years old. Rheumatic fever is associated with the development of valve disease and other heart disorders.

Acute rheumatic fever has 5 major diagnostic criteria:

• myocarditis (heart inflammation)
• migratory polyarthritis
• subcutaneous skin nodules
• chorea (Sydenham’s chorea)
• erythema marginatum.

Prevention: Prompt treatment of strep. infections may reduce the risk of development of rheumatic fever.

Symptoms:

• fever
• joint pain, "arthritis type" (location moves from joint to joint, migratory polyarthritis)
• joint swelling
• epistaxis (nosebleeds)
• abdominal pain
• vomiting
• skin rash (erythema marginatum)
  • enlarging red patch on the body
  • may be ring-shaped or snake-like in appearance
• skin nodules
• unusual, jerky movements (Sydenham’s chorea)

• muscle pain
• confusion
• decreased muscle tone, weakness
• shakiness of one or more parts of the body (Sydenham’s chorea)
• poor speech (Sydenham’s chorea)
• cough
• excessive tiredness, fatigue

Signs and Tests: An examination shows joint swelling, lumps, or skin changes over the joints or bony prominences.

• An ECG will demonstrate myocarditis (heart inflammation).
• An echocardiogram will show myocarditis.
• A chest X-ray may also be recommended.
• A CBC shows increased white blood cell count.
• The sedimentation rate (ESR, ZSR) is elevated.
• ASO and anti-DNAase B levels may be elevated.

• quantitative immunoglobulins (nephelometry)
• immunoelectrophoresis - serum
• complement component 3
• complement
• blood differential

Treatment: The goal of treatment is cure of the infection, which helps to prevent complications.

Antibiotics, preferably penicillin or erythromycin, are used to fight the infection. Antibiotics may be given long-term for chronic or resistant cases. Medications to reduce pain and swelling include aspirin, anti-inflammatory medications (NSAIDS and corticosteroids - oral), and analgesics. (Consult with your health care provider before giving aspirin or NSAIDS to children.)

Reduce your physical activity. Bedrest may be recommended for a time to allow the body to heal. Fluids are encouraged, often at least 6 to 8 glasses per day.

Prognosis: The recurrence of rheumatic fever is common. Joint and heart complications may be long-term and severe.

Complications:

• arthritis
• damage to heart valves (especially mitral stenosis)
• endocarditis
• stable angina
• heart failure
• arrhythmias
• pericarditis
• chronic skin disorders, sores
• chronically enlarged lymph nodes
• anemia
• protein in the urine (which may be associated with kidney damage)
• Sydenham’s chorea

Call your health care provider if symptoms of rheumatic fever are present.

Call for an appointment with your health care provider if you have an untreated infection that is probably caused by streptococcus bacteria (such as strep throat).