Rheumatic fever (patient information)

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 * Associate Editor-In-Chief: Jinhui Wu, M.D.; Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Rheumatic fever is a systemic immune disease that may develop after an infection with streptococcus bacteria, such as strep throat and scarlet fever. The disease can affect the heart, joints, blood vessels, and brain. Usual symptoms include fever, joint apin, joint swelling, skin nodules, skin rash, epistaxis, even cardiac problems such as shortness of breath, chest pain, and emotion changes. Medical history and physical examination are very important for diagnosis. Antistreptolysin O (ASO) titer can assist in making a diagnosis of rheumatic fever. Treatments include antibiotics to control streptococcus infection and medications such as aspirin and corticosteroids to decrease inflammatory. A long-lasting injection of penicillin is important and effective to prevent further complications and recurrence.

What are the symptoms of Rheumatic fever?

 * Fever
 * Joint problems, which mainly affect in the knees, elbows, ankles, and wrists, appear joint swelling, joint pain. Pain in one joint that migrates to another joint.
 * Skin nodules, skin rash (erythema marginatum) on the trunk and upper part of the arms or legs
 * Epistaxis
 * Cardiac problems, which may not have symptoms, or may result in shortness of breath, chest pain, palpitations and fatigue.
 * Sydenham chorea: It is uncontrollable body movements, most often in the hands, feet and face; less often in the arms and legs.
 * Emotion changes, such as crying or inappropriate laughing.

Diseases with similar symptoms:
 * Reactive arthritis
 * Rheumatoid arthritis
 * Myocarditis
 * Scarlet fever
 * Congenital heart disease
 * Huntington chorea

Who is at highest risk?
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.

When to seek urgent medical care?
Call your health care provider if you develop symptoms of rheumatic fever. Because several other conditions have similar symptoms, you will need careful medical evaluation.

If you have symptoms of strep throat, tell your health care provider. You will need to be evaluated and treated if you do have strep throat, to decrease your risk of developing rheumatic fever.

Diagnosis
Your doctor will come to a diagnosis by running the following methods
 * Medical history and physical examination: The doctor may suspect rheumatic fever when he/she finds fever, polyarthritis and subcutaneous nodules.
 * Blood tests: These tests can assist in making a diagnosis of rheumatic fever.
 * Antistreptolysin O (ASO) titer: It can be used to detect prior infection by group A Streptococcus by measuring antibodies against streptolysin O.
 * Complete blood count
 * Sedimentation rate (ESR): This test can measure how much inflammation is in the body. Patients with rheumatic fever may show an increased ESR.


 * Electrocardiogram: This test detects and records the electrical activity of the heart. An EKG also can show if you have arrhythmias.
 * Echocardiography: An echocardiogram uses sound waves to produce images of the heart. It may enable the doctor to detect structure and function of the heart. An echocardiogram can reveal damaged valves in the later peroid of the disease.

Treatment options
There is no special treatment for rheumatic fever once it has occured. Medications can be used to control streptococcal infection and relieve symptoms.
 * Bed rest: The length of bed rest depends on the severity of the disease and the involvement of the heart and joints. It usually ranges from two to twelve weeks.
 * Antibiotics: Antibiotics such as penicillin are used to control streptococcus infection. After the initial treatment, the patient is recommended to continue to receive monthly injections of a long-lasting preparation of penicillin to help prevent further complications and recurrence.
 * Anti-inflammatory medications: Medicatons such as aspirin or corticosteroids can be used to reduce inflammation to help relieve joint pain and decrease the swelling.

Where to find medical care for Rheumatic fever?
Directions to Hospitals Treating rheumatic fever

Prevention
The most important way to prevent rheumatic fever is to treat strep throat and scarlet fever early and effectively.

What to expect (Outlook/Prognosis)?
Prognosis of rheumatic fever depends on:
 * Complications, especially whether heart valves are damaged.
 * Whether the patient receives monthly antibiotics injection, especially during the first 3 -5 years after the first episode of the disease.

Possible complications

 * Arrhythmias
 * Damage to heart valves (in particular, mitral stenosis and aortic stenosis)
 * Endocarditis
 * Heart failure
 * Pericarditis
 * Sydenham chorea