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Rheumatic Fever: Causes, Treatment, and Prevention

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Rheumatic fever is an autoimmune disease that inflames the body’s tissues, such as the joints and heart. Healthcare providers may also call it acute rheumatic fever. It happens when the body’s immune system overreacts to a strep throat or scarlet fever infection that hasn’t been fully treated.

Rheumatic fever causes your body’s immune system to attack its own tissues, causing inflammation (swelling). Rheumatic fever may affect the joints, heart or blood vessels.

Rheumatic Fever

Are rheumatic fever and scarlet fever the same thing?

No. Scarlet fever and strep throat are infections caused by group A Streptococcus bacteria. Scarlet fever and strep throat are common group A Streptococcus infections. Healthcare providers treat them with antibiotics.

Rheumatic fever is a very rare complication of scarlet fever and strep throat. It can happen when one of these infections goes untreated.

How common is rheumatic fever?

While strep infections are common in the U.S., rheumatic fever is not. Because antibiotics are widely available in the U.S., most people get treatment for strep throat and scarlet fever. Clearing up these conditions prevents rheumatic fever.

Rheumatic fever happens more often in places with limited resources, such as resource-poor countries. But it can occur in the U.S., especially in areas with limited access to medical care.

What causes rheumatic fever?

Rheumatic fever is an overreaction of your body’s immune system that causes it to fight healthy tissues. An untreated strep throat or scarlet fever infection can trigger this overreaction. It happens when group A streptococcus infections are not adequately treated with antibiotics.

When your body’s defenses (antibodies) begin to fight back, the reaction can damage healthy tissues and organs instead of the bacteria.

Who gets rheumatic fever?

Anyone can get rheumatic fever. But it mostly affects young children and teenagers (ages 5 to 15). When people get rheumatic fever, it usually develops two to three weeks after an untreated strep throat or scarlet fever. Acute rheumatic fever generally does not occur in young children (less than 5y) and those older than 15 years.

How often does strep throat or scarlet fever cause rheumatic fever?

Most people who get strep throat or scarlet fever don’t develop rheumatic fever. It only happens when these conditions don’t get treated as they should. Even then, rheumatic fever is exceedingly rare in the U.S.

Who’s at risk for rheumatic fever?

Certain factors can increase your risk of getting rheumatic fever:

  • Where you live: Most people with rheumatic fever live in places that have limited medical resources, such as resource-poor countries. Living in an area where it’s difficult to get medication or medical care may also put you at risk.
  • Age: Rheumatic fever mostly affects children or teenagers between 5 and 15.
  • Overall health: Having a weakened immune system can increase your risk. Children who frequently get strep infections may be more likely to get rheumatic fever.
  • Family history: If someone in your family has had rheumatic fever, other family members may be more likely to get it.
  • Crowded areas: Bacteria spread more easily in places where large groups gather.

Can adults get rheumatic fever?

It’s very rare, but adults can also get rheumatic fever.

Is rheumatic fever contagious?

Rheumatic fever is not contagious. You can’t give it to or get it from someone else. But strep throat and scarlet fever are contagious. These infections spread through respiratory droplets (by coughing or sneezing on someone else).

What are the symptoms of rheumatic fever?

Rheumatic fever (and bacterial infections in general) can affect people in different ways. Sometimes, people experience such mild strep symptoms that they don’t realize they had a strep infection until rheumatic fever develops later on.

Rheumatic fever symptoms look similar to many other health issues. Most of these other problems are routine and not dangerous. Symptoms can vary widely, depending on what part of the body the disease impacts.

Because rheumatic fever can be serious, always call your provider if you suspect you or your child may have this condition. Common rheumatic fever symptoms include:

  • Swollen, tender and red joints, especially the large joints such as the knees, ankles and elbows
  • Chest pain or abnormal heartbeat.
  • Feeling overly tired all the time (fatigue).
  • Fever, especially one over 100.4 degrees Fahrenheit.
  • Flat, red rash with a jagged edge.
  • Unexplained or ongoing headaches, especially if your child has never complained of head pain before.
  • Jerky movements you can’t control in your hands, feet or other body parts.
  • Muscle aches or painful, tender joints.
  • Small bumps under the skin.
  • Swollen, red tonsils.

How is rheumatic fever diagnosed?

If you or your child has a sore throat for more than a couple of days, reach out to your healthcare provider. Treating a group A Streptococcal infection can prevent rheumatic fever.

If your provider suspects rheumatic fever, they will first swab your throat to check for group A streptococcus bacteria. They may use a rapid strep test or order a throat culture.

A rapid strep test can provide results within 10 minutes. A throat culture takes a few days to get results. However, rapid step tests sometimes give false-negative results (saying you don’t have strep when you really do).

Depending on your symptoms, your healthcare provider may also order:

  • Blood tests: Sometimes, providers order a blood test to confirm a strep infection. Blood tests can detect antibodies (your body’s defenses against the bacteria) when the bacteria no longer show up on tests. Other blood tests check for substances (like proteins) that show inflammation in the body.
  • Heart tests: Heart tests, such as an electrocardiogram (EKG) or an echocardiogram (Ultrasound of the heart), help providers check your heart function.

How is rheumatic fever treated?

Rheumatic fever treatments first focus on getting rid of the bacterial infection. Treatments then address inflammation inside the body.

Rheumatic fever treatments include:

  • Antibiotics: Healthcare providers prescribe antibiotics to treat the underlying bacterial infection. Some antibiotics are one injection (shot). Others you take by mouth for a week or more.
  • Anti-inflammatory medications: Your provider will likely recommend a medication, such as aspirin, to reduce inflammation (swelling) throughout the body. This medication may also relieve symptoms, such as joint pain. For severe symptoms, your provider may prescribe a stronger medication (corticosteroids) to fight inflammation.
  • Other therapies: Rheumatic fever can affect people in different ways. Your provider may recommend other treatments based on how the condition affects you. In severe cases, you may need heart surgery or joint treatments to treat serious complications.

How can I prevent rheumatic fever?

Treating strep throat and scarlet fever early is essential. It can prevent rheumatic fever. Strep throat and scarlet fever symptoms aren’t always obvious or easy to spot. Call your healthcare provider for guidance if your child has a sore throat for more than three days or has other symptoms that concern you.

If your child has strep throat or scarlet fever, make sure you follow your provider’s instructions carefully. Your child needs to finish the full course of antibiotics, even if they feel better. Otherwise, the infection may not go away and make you more prone to rheumatic fever.

What else can I do to protect against rheumatic fever?

Practicing good hygiene can reduce your chances of getting a bacterial infection. It can also stop you from spreading an infection to someone else. You should always:

  • Wash your hands often (and well) with soap and water.
  • Cough or sneeze into a tissue, your elbow or upper shoulder (not your hand).
  • Use a tissue once for a sneeze or to blow your nose, then throw it away and wash your hands.

If you have been diagnosed with rheumatic fever, your physician may prescribe a long term antibiotic (monthly injections of penicillin) to prevent future bouts of strep throat and to prevent recurrences of rheumatic fever.

What’s the outlook for people with rheumatic fever?

Rheumatic fever doesn’t have a cure, but treatments can manage the condition. Getting a precise diagnosis soon after symptoms show up can prevent the disease from causing permanent damage. Severe complications are rare. When they occur, they may affect the heart, joints, nervous system or skin.

Rheumatic disease can come back or become a serious problem. In some cases, rheumatic fever can lead to serious or even life-threatening complications. Your child may need regular checkups to protect their health long-term.

How does rheumatic fever affect the heart?

Rheumatic fever doesn’t always affect the heart. But when it does, it can damage heart tissues, especially the heart valves. Scarred heart tissue doesn’t work correctly. Over time, rheumatic fever may lead to permanent heart damage. Providers may call this condition rheumatic heart disease or congestive heart failure.

If rheumatic fever injures a heart valve, your provider may recommend surgery to repair or replace the affected valve. Heart damage may show up 10 to 20 years after a rheumatic fever diagnosis. It’s important to stay in regular contact with a healthcare provider you trust for the rest of your life.

Can rheumatic fever come back?

Yes. You can get rheumatic fever again if you get strep throat or scarlet fever again later. If you’ve had rheumatic fever, your provider may recommend you take antibiotics for years or possibly throughout your life. This treatment is called antibiotic prophylaxis. It can prevent another strep infection and keep rheumatic fever from coming back.

What should I ask my healthcare provider?

If you or your child has rheumatic fever, you may want to ask your provider:

  • What antibiotic do you recommend?
  • How long does my child need to take this medication?
  • Will my child need to take antibiotics long-term?
  • Will my child need other tests, now or in the future?
  • How could rheumatic fever affect my child, now or in the future?
  • Are there any activities that could pose a danger to my child’s health?
  • What type of medical care will my child need moving forward?
  • What can I do to best protect my child’s health?

When should I call the doctor?

If you suspect your child may have strep throat or scarlet fever, don’t wait to call your provider. Early treatment can prevent rheumatic fever.

Common signs of these bacterial infections include:

  • Sore throat that lasts more than three days.
  • Lack of appetite (especially if due to problems swallowing).
  • Swollen lymph nodes on the neck.
  • Red rash.
  • Fever.
  • Swollen, red, or spotted tonsils (glands in the back of the mouth).
  • Headache.
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