Rheumatic Fever: Signs, Symptoms, Diagnosis and Treatment Options

Rheumatic fever is a serious inflammatory disease that can affect children, usually between 5 and 15 years of age, following a throat infection caused by a bacteria called Streptococcus pyogenes (Group A streptococcus). Though its incidence has decreased in many developed countries due to better healthcare and widespread antibiotic use, it remains a significant health concern in developing regions, including parts of India.

When your child’s immune system overreacts to an untreated streptococcal infection, it can effect your child’s heart and joints.

What is Rheumatic Fever?

Rheumatic fever is an uncommon but serious Rheumatic fever is the body’s abnormal immune reaction to a streptococcal throat infection. Instead of fighting only the bacteria, the immune system mistakenly attacks healthy tissues in the heart, joints, skin, and brain. This leads to inflammation and various clinical symptoms.

This reaction can lead to inflammation in different parts of the body—especially the joints, heart, and blood vessels. Rheumatic fever is most commonly seen in children between the ages of 5 and 15, although it can affect younger kids and adults as well.

Why is it Important?

The most serious complication of rheumatic fever is rheumatic heart disease (RHD). If not managed properly, rheumatic fever can lead to long-term complications, particularly involving the heart. In some cases, it may result in damage to the heart valves or even lead to heart failure. Early diagnosis and proper treatment of strep infections are key to preventing rheumatic fever.

Signs and Symptoms of Rheumatic Fever

Rheumatic fever may present itself in various ways, and it affects most areas of the body. 

Symptoms typically appear 2–4 weeks after a streptococcal infection. Common signs include:

• Fever
• Painful, swollen joints: It typically occurs in large joints such as the knees, ankles, elbows, and wrists, often moving from one joint to another (migratory arthritis)
• Skin rash: erythema marginatum – pink rings with clear centers
• Small, firm lumps under the skin known as subcutaneous nodule
• Uncontrolled body movements: Sydenham chorea – jerky movements, emotional changes
• Inflammation of the heart (carditis): It is among the most dangerous complications. It may result in a rapid heartbeat, fatigue, shortness of breath, and pain during physical exertion. Carditis occurs in half of the affected children, and sometimes it results in lasting heart issues.

How is Rheumatic Fever Diagnosed

There is no single test to diagnose rheumatic fever. Physicians most often use a list of criteria known as the modified Jones criteria, a set of clinical features plus evidence of a recent strep infection to diagnose rheumatic fever. Investigations may include:

• Throat swab culture or rapid antigen test
• Blood tests (ASO titer, ESR, CRP)
• Aside from laboratory tests, your child’s pediatrician may recommend Electrocardiogram (ECG) and Echocardiogram to observe whether there is any damage to the heart valves or fluid accumulation around the heart.

Treatment Options for Rheumatic Fever

Treating rheumatic fever is a combination of acute and chronic care. Acutely, the infection is treated with antibiotics such as penicillin. Anti-inflammatory drugs such as aspirin are also administered to lower inflammation and pain in the heart and the joints.

In order to avoid the condition from re-emerging, the children are normally given penicillin therapy for several years. The long-term prevention is important since repeated infections can do additional harm to the heart, particularly the valves.

When to consult a physician

Rheumatic fever is preventable. Prompt recognition and treatment of streptococcal throat infections remain the most effective way to safeguard children from this disease and its complications. Make an appointment with a healthcare practitioner if any of these symptoms of streptococcal throat occur:

• Sudden onset of a sore throat
• Pain or discomfort while swallowing
• High temperature or fever
• Swollen, red tonsils (sometimes with white patches or pus)
• Swollen, tender lymph nodes in the neck
• Headache, abdominal pain, nausea or vomiting 

Timely medical care can make all the difference in protecting your child’s long-term health.

Conclusion

Rheumatic fever is an uncommon but serious condition that can develop if strep throat or scarlet fever isn’t treated in time. It mostly affects children and teenagers and, in severe cases, may cause lasting damage to the heart, joints, or other organs. If you notice symptoms of strep or scarlet fever in your child, don’t delay—see a doctor promptly. Early treatment can help prevent complications like rheumatic fever. For expert care, consult a pediatric immunologist or rheumatologist.