Rheumatic fever is thought to be an autoimmune disorder triggered by the body's immune response to GABHS during an episode of strep throat. That is, the antibodies that the body produces to fight the strep infection can become "confused," and begin attacking various organs within the body. The most serious complication of rheumatic fever is an inflammation of the heart (called carditis), which can lead to rheumatic heart disease.
Rheumatic fever is seen almost exclusively in children and adolescents. While rheumatic fever was very common in the United States 100 years ago (and in fact was a leading cause of death in young people), it is now quite rare in developed countries. Rheumatic fever remains a major problem, however, in undeveloped countries.
The reduction in rheumatic fever is thought to be due to the aggressive treatment of suspected strep throat with antibiotics.
Symptoms of Rheumatic Fever
Symptoms of rheumatic fever can include:- Fever, headache, weakness, weight loss, sweating, and other general signs of illness
- Joint pain that moves from joint to joint (that is, "migratory" joint pain)
- Chest pain suggestive of pericarditis
- Personality changes, especially irritability and short attention span
- Involuntary muscle movements (chorea - an involuntary movement disorder, in which the limbs move in a wormlike, almost graceful way, but completely involuntarily)
- Rash
Doctors will diagnose rheumatic fever if you have at least one of the symptoms listed above, blood tests or throat culture indicate recent infection with GABHS, and at least one of the following signs are found:
- Carditis (this can be either pericarditis, inflammation of the heart muscle, or inflammation of the heart valves)
- Arthritis involving more than one joint
- Chorea
- Bumps under the skin (subcutaneous nodules)
- Erythema marginatum (a distinctive rash)
Treatment of Rheumatic Fever
Anyone diagnosed with acute rheumatic fever should be treated aggressively. Treatment includes:- A course of antibiotics to get rid of any GABHS that may be provoking an ongoing immune response
- Anti-inflammatory medicines including aspirin (which in high doses usually produces a dramatic response in rheumatic fever), and possibly steroid therapy (especially if carditis is present)
- Treatment with antibiotics (at least until age 21) to prevent recurrences of rheumatic fever. This is called prophylactic antibiotic therapy. (Here are the American Heart Association's recommendations on prophylaxis for rheumatic fever.)
Long-term Risks After Rheumatic Fever
Once acute rheumatic fever has resolved, the long-term risks are almost completely related to the risk of developing chronic rheumatic heart disease. In addition, once you have had an episode of rheumatic fever, your chances of getting it again go up significantly, so following your doctor's recommendations for prophylactic antibiotics is critically important.People who have recovered from rheumatic fever ought to have a baseline cardiac evaluation, including an echocardiogram. Annual re-evaluations should be done, consisting at least of a physical examination, to see if any new heart murmurs have appeared (which might indicate that rheumatic heart disease is present). If the physical examination suggests a change, then a repeat echocardiogram should be sufficient to determine whether rheumatic heart disease is present.
Here's more on rheumatic heart disease, the most serious complication of rheumatic fever.
Source:
Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. JAMA 1992; 268:2069.
