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Rheumatic Fever
Rheumatic Fever
• Rheumatic fever is an inflammatory disease
that may develop after an infection with
Streptococcus bacteria (such as strep throat or
scarlet fever). The disease can affect the heart,
joints, skin, and brain.
Causes, Incidence, and Risk Factors
• Rheumatic fever is common worldwide and is
responsible for many cases of damaged heart
valves. It is not common in the United States,
and usually occurs in isolated outbreaks. The
latest outbreak was in the 1980s.
• Rheumatic fever mainly affects children ages 6
-15, and occurs approximately 20 days after
strep throat or scarlet fever.
• Abdominal pain
• Fever
• Heart (cardiac) problems, which may not
have symptoms, or may result in
shortness of breath and chest pain
• Joint pain, arthritis (mainly in the knees,
elbows, ankles, and wrists)
• Joint swelling; redness or warmth
• Nosebleeds (epistaxis)
• Skin nodules
• Skin rash (erythema marginatum)
• Skin eruption on the trunk and upper
part of the arms or legs
• Eruptions that look ring-shaped or snakelike
• Sydenham chorea (emotional instability,
muscle weakness and quick,
uncoordinated jerky movements that
mainly affect the face, feet, and hands)
Signs and Tests
• Because this disease has different forms, no one
test can firmly diagnose it. The doctor will
perform a careful exam, which includes checking
your heart sounds, skin, and joints.
Tests may include:
– Blood test for recurrent strep infection (such as an
ASO test)
– Complete blood count
– Electrocardiogram
– Sedimentation rate (ESR)
Signs and Tests Continued
Several major and minor criteria have been developed to help standardize Rheumatic
fever diagnosis. Meeting these criteria, as well as having evidence of a recent
streptococcal infection, can help confirm that you have rheumatic fever.
The major criteria for diagnosis include:
Arthritis in several joints (polyarthritis)
Heart inflammation (carditis)
Nodules under the skin (subcutaneous skin nodules)
Rapid, jerky movements (chorea, Sydenham chorea)
Skin rash (erythema marginatum)
The minor criteria include:
High ESR (erythrocyte sedimentation rate)
Joint pain
Other laboratory findings
You'll likely be diagnosed with rheumatic fever if you meet two major criteria, or one major and two
minor criteria, and have signs that you've had a previous strep infection.
Treatment & Prognosis
• If you are diagnosed with acute rheumatic fever you will be treated
with antibiotics.
• Anti-inflammatory medications such as aspirin or corticosteroids
reduce inflammation to help manage acute rheumatic fever.
• You may have to take low doses of antibiotics (such as penicillin,
sulfadiazine, or erythromycin) over the long term to prevent strep
throat from returning.
Expectations (prognosis)
• Rheumatic fever is likely to come back in people who don't take
low-dose antibiotics continually, especially during the first 3 -5 years
after the first episode of the disease. Heart complications may be
severe, particularly if the heart valves are involved.
• The most important way to prevent rheumatic
fever is by getting quick treatment for strep
throat and scarlet fever.