Rheumatic fever is an inflammatory disease that develops when strep infections are not properly treated. Children aged 5 to 15 years old are the most commonly affected but it can also develop in young adults. If left untreated, rheumatic fever can progress into rheumatic heart disease and cause permanent damage to the heart.

Rheumatic fever is caused by group A streptococcus bacteria, the primary agent for strep infections. Some possible forms of strep infections include pharyngitis (strep throat), tonsillitis, sinusitis, and ear infections. The first signs of acute rheumatic fever normally appear two to three weeks after the initial strep infection.

Rheumatic fever can present with five major manifestations classified under the Jones criteria:

• Arthritis – swelling of the joints
• Carditis – swelling of the heart
• Subcutaneous nodules – solid bumps under the skin
• Erythema marginatum – round, pink rashes with raised borders
• Sydenham chorea – involuntary, unpredictable movement of the muscles

The following are some minor symptoms that can also appear:

• Fever
• Painful joints
• Chest pain
• Fatigue

A recent history of strep infection and the presence of the Jones criteria are key to clinically diagnosing patients with rheumatic fever.

A recent or current strep infection can be confirmed through laboratory tests such as serology, and the measurement of CRP or ESR. If there are symptoms that affect the heart, a chest x-ray, electrocardiogram, or an echocardiogram can be performed to see how serious the involvement is.

The primary goals of treatment is to eradicate all of the responsible bacteria and to manage the symptoms of the disease. The antibiotic of choice for rheumatic fever is intramuscular benzathine penicillin or amoxicillin. Other supportive medication depends on the presenting symptoms. NSAIDs, such as ibuprofen, are given for arthritis and heart failure drugs are given for carditis.

The only way to prevent rheumatic fever is to treat strep infections immediately and correctly, with a full course of proper antibiotics. It is important to continue with the medical regimen even after symptoms subside to ensure all of the bacteria are killed and they do not develop resistance to future treatment. In the most serious cases wherein there is permanent heart valve damage, lifelong antibiotic prophylaxis is done to prevent strep infections from recurring and causing the same disease.

References:

Steer, A, & Gibofsky, A. (2022). Acute rheumatic fever: Clinical manifestations and diagnosis. UpToDate. https://www.uptodate.com/contents/acute-rheumatic-fever-clinical-manifestations-and-diagnosis

Steer, A, & Gibofsky, A. (2022). Acute rheumatic fever: Treatment and prevention. UpToDate. https://www.uptodate.com/contents/acute-rheumatic-fever-treatment-and-prevention