What is rheumatic fever?

Rheumatic fever is a complex disease that affects the joints, skin, heart, blood vessels, and brain. It happens mainly in children between the ages of 5 and 15. It's an autoimmune disease that occurs after an infection with strep (streptococcus) bacteria. Strep infections include strep throat and scarlet fever. Rheumatic fever happens more often in the winter and spring. This is because strep throat infections occur more often in these seasons. Strep is contagious. This means it can be spread from child to child. But rheumatic fever is not contagious.

What causes rheumatic fever?

Rheumatic fever is an autoimmune reaction to the strep bacteria. An autoimmune reaction is when the body attacks its own tissues. It can be prevented if strep throat is diagnosed right away and treated correctly with antibiotics. Rheumatic fever is not common in the U.S.

Who is at risk for rheumatic fever?

Children ages 5 to 15 are most at risk for having rheumatic fever. They are most at risk if they:

• Have strep throat infections often.

• Have strep infections that were not treated or not treated enough.

• Have a family history of rheumatic fever.

What are the symptoms of rheumatic fever?

The symptoms usually start about 1 to 5 weeks after a child has been infected with strep bacteria. Each child’s symptoms may vary. Common symptoms include:

• Inflammation in joints, such as the knees or ankles, that causes swelling, soreness, and redness.

• Small, painless, hard bumps (nodules) under the skin, often over bony areas.

• Unusual jerky movements, most often of the face and hands. This is often noted by a change in a child's handwriting.

• Red rash with odd edges on the torso, arms, or legs.

• Fever.

• Weight loss.

• Lack of energy (fatigue).

• Stomach pains.

These symptoms can seem like other health conditions. Have your child see their doctor for a diagnosis.

How is rheumatic fever diagnosed?

Your child’s doctor will take your child’s health history and do a physical exam. Your child may also have tests, such as:

• Blood tests. These are done to look for signs of inflammation, recent strep infection, and other related problems.

• Electrocardiogram (ECG). This is a test that records the electrical activity of the heart. It shows abnormal rhythms and detects heart muscle damage.

• Echocardiogram. This test determines how well the heart muscle is working.

• Throat culture. A swab is wiped on the throat. This is done to look for the strep bacteria.

Your child's doctor will look for:

• Inflammation of the heart.

• Inflammation of more than 1 joint.

• Unusual jerky movements.

• Small, hard bumps under the skin.

• Red, irregular rash.

• Fever.

• Pain in 1 or more joints.

• Previous inflammation of the heart.

• Changes in the ECG pattern.

• Abnormal sedimentation rate or C-reactive protein in blood tests.

How is rheumatic fever treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how bad the condition is.

 Treatment for rheumatic fever often combines the following 3 things:

• Treatment for strep. The first step is to treat the strep infection with antibiotics. This is done even if a throat culture is negative. Your child may need to take monthly doses of antibiotics to prevent future strep infections. This is to help prevent the rheumatic fever from coming back and further damaging the body.

• Anti-inflammatory medicines. Your child may take medicines such as aspirin, corticosteroids or anti-inflammatory medicines. They help decrease the swelling that happens in the heart muscle. The medicines also help ease joint pain.

• Bed rest. The length of bed rest will depend on how bad your child's illness is. Bed rest may range from 2 to 12 weeks.

Talk with your child’s doctor about the risks, benefits, and possible side effects of all medicines.

What are possible complications of rheumatic fever?

If the illness severely attacks a child's heart, this may damage heart valves and cause heart disease. In this case, your child may not be allowed to do some kinds of physical activity and sports.

If the heart were damaged, your child would need to take special care when going to the dentist in the future. They may need to take antibiotics before having dental work done. This helps lower the chance of an infection traveling to the heart during a dental procedure. Talk with your child's doctor for more information.

Can rheumatic fever be prevented?

The best way to prevent rheumatic fever is to treat strep throat infections right away. Give the antibiotics to your child as directed. Do not stop giving them just because your child feels better. Your child needs to take the full course of antibiotics.

Helping your child live with rheumatic fever

Having rheumatic fever increases your child's chances of having the disease again. This is at highest risk during the first 3 years. The chance of having the disease again lessens with age and time.

After having rheumatic fever, your child will need to take antibiotics on an ongoing basis. This is to lower the chance of having rheumatic fever again. Antibiotics (usually penicillin) may be given by mouth or by a monthly injection. Talk with your child's doctor about how long this treatment is needed. It depends on how bad your child's rheumatic fever is and is usually continued at least 5 years or until age 21, whichever is longer. Some people, like those with heart valve problems, may need to take antibiotics for life. Your child's doctor will be able to help you learn more.

When should I contact my child's doctor?

Contact the doctor if your child's symptoms get worse or they have new symptoms.

Key points about rheumatic fever

• Rheumatic fever is a complex disease that affects the joints, skin, heart, blood vessels, and brain.

• It happens after an infection with strep bacteria, such as strep throat or scarlet fever.

• Symptoms may include joint inflammation, small, hard bumps under the skin, jerky movements, a rash, and fever.

• Treatment includes antibiotics, anti-inflammatory medicine, and bed rest.

• Your child will need to have ongoing treatment to stop the disease from coming back.

Next steps

Tips to help you get the most from a visit to your child’s doctor:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s doctor after office hours. This is important if your child becomes ill and you have questions or need advice.