Overview
Rheumatic fever is an inflammatory disease that can develop in some individuals, usually children between 5 and 15 years old, as a complication of an untreated streptococcal bacterial infection, such as strep throat or scarlet fever. If strep throat or scarlet fever isn't properly treated, the immune system can react to the streptococcus bacteria by causing inflammation in various parts of the body, including the heart, joints, skin, and central nervous system. This can result in symptoms such as fever, painful and tender joints, chest pain, fatigue, and a rash. In some cases, rheumatic fever can lead to permanent damage to the heart, including damaged heart valves and heart failure. Treatment can help manage symptoms, reduce inflammation, and prevent further complications.
Understanding the disease
Symptoms
The symptoms of rheumatic fever can include fever, painful and tender joints (most often in the knees, ankles, elbows, and wrists), chest pain, fatigue, a flat or slightly raised painless rash with a ragged edge, a heart murmur, jerky uncontrollable body movements (Sydenham chorea), and small painless bumps beneath the skin. Other symptoms may include outbursts of unusual behavior, shortness of breath, and skin or soft-tissue infection. It's important to seek medical attention if these symptoms occur or if there are signs of infection, such as swelling, warmth, or redness in the affected area, pain in the area of the infection, or lesions with pus or drainage. Rheumatic fever can cause permanent damage to the heart and lead to heart failure if not properly treated.
Risk Factors
The risk factors for developing rheumatic fever include:
- Genes: Some people have one or more genes that might make them more likely to develop rheumatic fever.
- Specific type of strep bacteria: Certain strains of strep bacteria are more likely to contribute to rheumatic fever than are other strains.
- Environmental factors: A greater risk of rheumatic fever is associated with overcrowding, poor sanitation, and other conditions that can cause strep bacteria to easily spread among many people. It is important to note that while genetic factors may play a role, the exact cause of rheumatic fever is not entirely understood.
Development
Rheumatic fever is caused by an inadequately treated streptococcal infection, such as strep throat or scarlet fever. The streptococcus bacteria trigger an autoimmune response in the body, leading to inflammation in various organs, including the heart, joints, skin, and central nervous system. This faulty immune system reaction causes the body to attack healthy tissues, resulting in the symptoms of rheumatic fever.
Assessment and Diagnosis
Triage
When experiencing symptoms of rheumatic fever, it is important to consult a healthcare provider. If any of the signs or symptoms listed are present, such as fever, painful and tender joints, chest pain, fatigue, rash, or heart murmur, you should seek medical attention. This is particularly important if these symptoms arise after a recent strep throat infection or if there is a suspicion of rheumatic fever. Early diagnosis and treatment can help manage the condition, reduce inflammation, and prevent further damage to the heart or other organs.
Diagnosis
To diagnose rheumatic fever, symptoms, medical history, a physical exam, and specific test results are considered. There's no single test for rheumatic fever, but diagnostic tests may include blood tests to check for inflammation markers such as C-reactive protein and the erythrocyte sedimentation rate, an electrocardiogram to record the electrical activity of the heart, and an echocardiogram to visualize the heart in motion. Rheumatoid arthritis, on the other hand, is difficult to diagnose in its early stages, and there's no single test to confirm the diagnosis. Blood tests may be used to check for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies, and a healthcare provider may recommend bed rest and restricting activities until symptoms improve if inflammation affects the heart.
Management and Treatment
Complications
Potential complications of rheumatic fever include permanent damage to the heart, specifically rheumatic heart disease. Rheumatic heart disease can lead to damaged heart valves and heart failure. Other complications include narrowing of a heart valve (valve stenosis), leaky heart valve (valve regurgitation), damage to heart muscle, and irregular or chaotic heartbeats (atrial fibrillation). Rheumatic fever can also affect joints, skin, and the central nervous system.
Treatment
Treatment for rheumatic fever typically includes antibiotics to treat the underlying streptococcal infection, anti-inflammatory drugs to reduce inflammation, fever, and pain, and antiseizure drugs for severe involuntary movements caused by Sydenham chorea. Preventive antibiotic treatment is usually prescribed to prevent recurrence of rheumatic fever. People who have had heart inflammation during rheumatic fever may need to continue preventive antibiotic treatment for 10 years or longer. Discuss with a healthcare provider about the required follow-up and long-term care for the child. Heart damage caused by rheumatic fever may not show up for many years, so it is essential to inform healthcare providers about any history of rheumatic fever.
Preparing for medical consultation
To prepare for an appointment for rheumatic fever, make a list of your child's symptoms, recent illnesses, all medications taken, and questions to ask the health care provider. Be aware of any pre-appointment restrictions, such as isolation or dietary restrictions. Also, gather your child's vaccination record and medical history. Note any signs and symptoms, including those that may seem unrelated to rheumatic fever, and any major stresses or recent life changes. Consider bringing a family member or friend along for support and to help remember information discussed during the appointment.