Introduction

Rheumatic fever is a rare but potentially serious inflammatory condition that can affect various parts of the body, particularly the heart, joints, brain and skin. Although it is now relatively uncommon in developed countries, it remains a significant health concern in some regions of the world. Rheumatic fever often causes an untreated or inadequately treated streptococcal throat infection to accumulate, and it primarily affects children and adolescents.¹ This article aims to provide a comprehensive overview of rheumatic fever, covering its causes, symptoms, diagnosis and treatment.

Causes of rheumatic fever

Rheumatic fever is triggered by an untreated or inadequately treated infection with Group A Streptococcus bacteria. This bacterium causes strep throat, a common and usually mild infection. However, if the streptococcal infection is not properly treated with antibiotics, it can lead to the development of rheumatic fever in some individuals.

The exact mechanism by which streptococcal infections progress to rheumatic fever is not fully understood. It is believed that the body's immune response to the streptococcal infection may inadvertently attack its own tissues, resulting in the inflammation seen in rheumatic fever. Genetic factors may also play a role, as some individuals may be more susceptible to developing the condition than others.

Symptoms of rheumatic fever

The symptoms of rheumatic fever can vary widely and may affect different parts of the body. The most common symptoms include:

Joint pain and swelling

Rheumatic fever often presents with painful and swollen joints, a condition known as arthritis. The joints - especially those in the knees, ankles, elbows and wrists - may become red, warm and tender.

Cardiac involvement

Rheumatic fever can lead to inflammation of the heart, known as rheumatic heart disease. Symptoms of cardiac involvement may include chest pain, shortness of breath and an irregular heartbeat.

Skin manifestations

Skin rashes specific to rheumatic fever, known as erythema marginatum, may develop in children. These rashes are typically painless and have a characteristic appearance of spots with pink borders and pale centres.²

Chorea

Some individuals with rheumatic fever may experience involuntary and purposeless movements, a condition known as Sydenham's chorea.

Fever and fatigue

Fever, fatigue and a general feeling of unwellness are common symptoms in individuals with rheumatic fever. It's important to note that the symptoms of rheumatic fever may not appear immediately after a streptococcal infection. There is often a delay, and symptoms may develop weeks to months after.

Diagnosis of rheumatic fever

Diagnosing rheumatic fever can be challenging as there is no specific test that definitively confirms the condition (as elaborated in a study).³ Healthcare providers typically rely on a combination of clinical evaluation, medical history, and laboratory tests to make a diagnosis.

Throat cultures

A throat culture may be performed to identify the presence of Group A Streptococcus bacteria. This can help determine if the individual has had a recent streptococcal infection. The procedure involves the light brushing of a cotton swab against a patient’s throat to collect a cell and/or bacterial sample to be sent off to a lab for analysis.

Blood tests

Blood tests may be conducted to check for elevated levels of certain antibodies (immune response particles), such as anti-streptolysin O (ASO) and anti-DNase B. Elevated levels of these specific antibodies can suggest a recent streptococcal infection.

Electrocardiogram (ECG) and echocardiogram

If cardiac involvement is suspected, an ECG and echocardiogram may be performed to assess the heart's function and detect any abnormalities.

Clinical criteria

Diagnosis also involves meeting specific clinical criteria outlined by organisations such as the American Heart Association (AHA) or the World Health Organization (WHO). These criteria include the presence of certain symptoms and the exclusion of other potential causes.

It's crucial for healthcare providers to consider all aspects of the patient's presentation and history when making a diagnosis, as the symptoms of rheumatic fever can overlap with other conditions.

Treatment of rheumatic fever

The primary goal of treating rheumatic fever is to eliminate the underlying streptococcal infection and manage the associated symptoms.

Treatment typically involves the following components:⁴

Antibiotics

Antibiotics, such as penicillin or other suitable alternatives, are prescribed to eliminate the streptococcal bacteria. The course of antibiotics is usually longer than that for a typical strep throat infection.

Anti-inflammatory medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be used to alleviate joint pain and reduce inflammation.

Corticosteroids

In severe cases or when there is significant cardiac involvement, corticosteroids may be prescribed to reduce inflammation.

Bed rest

Bed rest may be recommended during the acute phase of the illness, especially if the joints or heart are affected.

Secondary prophylaxis

Individuals who have had rheumatic fever are often prescribed long-term antibiotic prophylaxis to prevent recurrent streptococcal infections, as these could trigger a recurrence of rheumatic fever.

Monitoring and follow-ups

Regular follow-up appointments are crucial to monitor the individual's progress, assess cardiac health, and adjust treatment as needed.⁴

It's essential for individuals with rheumatic fever to complete the full course of antibiotics and adhere to their treatment plan to prevent complications and reduce the risk of recurrence.

Complications of rheumatic fever

If left untreated or inadequately treated, rheumatic fever can lead to various complications, including:

Rheumatic heart disease

Chronic inflammation of the heart valves can result in permanent damage, leading to rheumatic heart disease. This condition can cause valve stenosis (narrowing) or regurgitation (leakage), affecting the heart's ability to pump blood efficiently.

Heart failure

Severe cases of rheumatic heart disease can contribute to heart failure, where the heart is unable to pump enough blood to meet the body's needs.

Joint damage

Prolonged inflammation of the joints can lead to joint damage and deformities.

Neurological complications

Sydenham's chorea, a neurological manifestation of rheumatic fever, may result in long-term neurological problems.

Prevention of rheumatic fever

Preventing rheumatic fever involves prompt and effective treatment of streptococcal infections as mentioned in a study.¹ Key prevention strategies include:

Prompt treatment of strep throat:

Individuals with symptoms of strep throat, such as sore throat, fever and swollen lymph nodes, should seek medical attention promptly. If a streptococcal infection is confirmed, antibiotics should be started as soon as possible.

Complete antibiotic course

It is crucial for individuals prescribed antibiotics to complete the full course, even if symptoms improve before the medication is finished.

Secondary prophylaxis

Long-term antibiotic prophylaxis may be recommended for individuals who have had rheumatic fever to prevent recurrence.

Public health measures

Public health measures, such as improved sanitation and access to healthcare.

Summary

It is essential for individuals suffering from a sudden accumulation of joint pain, fever and skin rashes to seek the advice of a doctor immediately. It is vital for the diagnosis and treatment of rheumatic fever to be quickly administered before it has the chance to manifest into other cardiac or neurological conditions. Always follow the prescription set by your doctor and take the appropriate dosage of antibiotics to help the fever subside as quickly as possible.
To avoid you or your child from having rheumatic fever or strep throat, make sure to wash your hands with soap and water, especially after coming home from outside.