Rheumatic fever

is an inflammatory disease that can develop as a complication of inadequately treated strep throat or scarlet fever. Strep throat and scarlet fever are caused by an infection with streptococcus bacteria.

OVERVIEW

Rheumatic fever is an inflammatory disease that can cause permanent damage to the heart and heart failure. Rheumatic fever is most common in children ages 5 to 15 years old. It is very rare in the US. Rheumatic Fever Causes Rheumatic fever is an inflammation in the heart, joints, skin or central nervous system that can occur following inadequately treated strep throat or scarlet fever. These diseases are caused by an infection with group A streptococcus bacteria. Proper treatment of strep can prevent rheumatic fever. The link between the strep bacteria and rheumatic fever is unclear. It appears that the bacteria trick the immune system into attacking certain body tissues, which results in ongoing inflammation that may last for a few weeks to several months. Sometimes, the inflammation causes long-term problems, including rheumatic heart disease. Rheumatic Fever Symptoms Rheumatic Fever Diagnosis The diagnosis is made based on a physical examination, during which the doctor will check for fever, joint inflammation, rash or nodules under the skin, abnormal heart rhythms or murmur and signs of nerve inflammation, which is done by performing a few simple movement tests. If strep throat was previously diagnosed and treated, the doctor will order a blood test that will look for antibodies related to the infection in the blood. Heart function may be examined using tests called electrocardiography and echocardiography. Rheumatic Fever Treatment An antibiotic, such as penicillin, is prescribed to eliminate any remaining bacteria. Long-term antibiotic treatment is also prescribed to prevent recurrence of rheumatic fever. To curb the inflammation and pain, nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, are also recommended. If inflammation is severe, corticosteroids, such as prednisone, may be used. Anticonvulsants, such as valproic acid or carbamazepine, may be given to reduce involuntary movements. Rheumatic Fever Self Care If heart tissues are affected by inflammation, strict bed rest is necessary for a few weeks or months until symptoms improve. Long-term follow-up care is necessary, as permanent heart damage may show up well after the acute fever phase of the disease has gone away. If a child has had rheumatic fever, it is important to include this in his or her medical history even when they reach adulthood, as they will need regular heart exams.

Although occasional flares of joint pain occur throughout the course of the disease, these can usually be controlled with the use of anti-inflammatory medication, especially early in their course. When joint subluxations and deformity take place, performing basic daily tasks (eg, writing and holding utensils) can become a problem. Some patients resort to the use of custom-designed writing instruments or utensils to overcome this difficulty. Permanent disability occurs in approximately 10-20% of patients. See the images below.