Rheumatic Fever

Rheumatic fever is an inflammatory disease that occasionally occurs as a delayed complication of a streptococcal infection of the upper respiratory tract (usually strep throat). The disease is characterized by inflammation of one or more organ sites throughout the body, including the joints (hence the name “rheumatic,” or joint-related, fever), the heart, the skin and the central nervous system.

Symptoms typically appear within one to five weeks after infection with group A streptococcal bacteria and include fever, painful and swollen joints and a skin rash. Untreated attacks usually subside in about three months. With prompt diagnosis and treatment, the disease is usually short-lived, although symptoms may continue for as long as six months with severe heart involvement.

The most serious manifestations of rheumatic fever involve the heart muscle and valves. Congestive heart failure can develop and may be fatal. The only long-term complication of rheumatic fever is valvular heart disease, a thickening or distortion in the heart valves that prevents them from closing properly or opening fully. Such damage may not be detected for many years.

Sydenham’s chorea, commonly known as St. Vitus’ dance, is a condition that affects around 15% of rheumatic fever patients and is characterised by emotional instability and uncontrollable jerking motions of the limbs or face muscles. Although in the United States, drugs and improved public health conditions have kept the occurrence under check, rheumatic fever can still happen in isolated cases or as part of an epidemic outbreak that affects many individuals. Rheumatic fever is most prevalent in children between the ages of five and 15, just as strep infections in general.

What Causes Rheumatic Fever?

  • Rheumatic fever is believed to result from an immune response by the body to specific strains of streptococcal bacteria. It is this immune reaction, and not the infection per se, that produces the inflammatory lesions in the various tissues throughout the body.

Symptoms of Rheumatic Fever

  • Sore throat precedes the illness by some weeks.
  • Especially in the knees, ankles, wrists, and elbows, joints become swollen and uncomfortable. The signs of arthritis may progress successively from one joint to another.
  • Fever
  • Excessive fatigue
  • Evanescent raised, red patches on the skin, in a curved latticelike pattern
  • Small, painless, pea-size lumps or nodules beneath the skin, commonly appearing on the hands, elbows, knees, scalp, shoulder blades, and spine.
  • Acute abdominal pain
  • Extreme emotional instability and jerky, unconscious motions (Sydenham’s chorea)
  • Stomach pain or feeling less hungry
  • Shortness of breath, weakness or feeling very tired
  • Weight loss


  • If your sore throat persists for more than 48 hours or is accompanied by a fever, get medical attention right once. Antibiotics should be taken as soon as possible to avoid the onset of rheumatic fever.

Diagnosis of Rheumatic Fever

  • Patient history and physical examination. A characteristic heart murmur may be detected with a stethoscope if the disease has affected a heart valve.
  • Blood tests for the presence of antibodies against streptococcal proteins.
  • Throat culture, to detect a streptococcal infection.
  • An electrocardiogram (ECG), a measurement of the heart’s electrical activity, may be done to detect carditis or other heart abnormalities.

How to Treat Rheumatic Fever

  • Antibiotics, usually penicillin or erythromycin, are given to eliminate streptococcal bacteria even though the bacteria are usually absent by the time rheumatic fever occurs.
  • Aspirin or another anti-inflammatory drug is usually given to control joint pain and swelling.
  • For more severe inflammation, corticosteroids may be needed.
  • Penicillin, taken daily by mouth or, less often, given by monthly injection, is continued for years to prevent reinfection.
  • Preventive doses of penicillin or amoxicillin may be required prior to dental or surgical procedures throughout the patient’s life.
  • Sedatives and tranquilizers (such as diazepam or chlorpromazine) may be prescribed to treat Sydenham’s chorea, the unusual complication of rheumatic fever that causes jerky, uncontrolled movements and mood swings.

When to Call a Doctor

  • If you have a sore throat that persists for more than 48 hours, especially if it is accompanied by a fever, consult your doctor.