Rheumatic Fever

Rheumatic fever is an inflammatory disease that can affect the heart, joints, skin or brain. (Read about "The Heart & Its Valves" "Skin" "The Brain") It results from an inflammatory reaction to certain streptococcus A bacteria. (Read about "Microorganisms") Those are the bacteria responsible for strep throat. (Read about "Sore Throat & Strep Throat") The body produces antibodies to fight the bacteria, but instead the antibodies attack some of the body's own connective tissues. (Read about "The Immune System") The infection can cause serious heart damage, in particular, the scarring of the heart valves. That scarring could force the heart to work harder to pump blood. The heart damage may resolve on it own or it may be permanent. According to the National Heart Lung and Blood Institute (NHLBI), heart damage caused by rheumatic fever can manifest itself even years after recovery from the disease itself.

The National Institute of Allergy and Infectious Diseases (NIAID) reports that rheumatic fever can develop two to three weeks after a bout of strep throat, even after the strep has cleared up. NIAID reports rheumatic fever most frequently affects children aged 5 to 15 years old.

The disease was once a common cause of heart problems in childhood and remains a serious childhood health problem in many developing countries. But in North America, it's become much less common due to improved hygiene and routine use of antibiotics. (Read about "Antibiotics")

The National Institutes of Health (NIH) lists several symptoms of rheumatic fever. They include:

• abdominal pain
• fever
• possible heart problems that may result in shortness of breath and chest pain
• joint inflammation resulting in swelling, tenderness and/or redness
• a change in neuromuscular movements called sydenham chorea when muscles in the torso, arms, and legs move involuntarily in a jerky manner
• nosebleeds
• skin nodules or hard round bumps under the skin
• a pink skin rash with odd edges that is usually seen on the trunk of the body or arms and legs (Read about "Skin Rash")

According to NIH, tests to determine the presence of rheumatic fever may include:

• blood test to determine a strep infection (ASO test)
• complete blood count (Read about "Complete Blood Count")
• electrocardiogram, which is a test that records the heart's activity by measuring electrical currents through the heart muscle (Read about "EKG - Electrocardiogram")
• sedimentation rate (ESR), which is a blood test to measure inflammation in the body

The goals of treatment are pretty simple. The first is to kill the strep bacteria. After that, treatment is to take care of the joint inflammation caused by the rheumatic fever, and finally to prevent future rheumatic fever attacks. To accomplish those goals, NIH says treatment can include:

• antibiotics to treat the strep infection
• anti-inflammatory medication such as aspirin or corticosteroids to reduce joint inflammation

Antibiotics may be required over the long term to prevent the strep infection from returning. NIH reports continual low dose antibiotics may be required, especially during the first 3-5 years after the first episode of the disease.

The best treatment for rheumatic fever is prevention. It is important to treat strep throat with antibiotics promptly to reduce the risk of developing rheumatic fever. NIH recommends calling your healthcare provider if you or your child has symptoms of strep throat. NHLBI also stresses it is very important to take all of the antibiotics your doctor may prescribe for strep throat, even if you feel better before the medicine is gone.