Rheumatic fever is a complex disease that affects the joints, skin, heart, blood vessels, and brain. It occurs mainly in children between the ages of 5 to 15. It is an immune disease that may occur after an infection with strep (streptococcus) bacteria. Strep infections include strep throat and scarlet fever. Rheumatic fever happens more often in the winter and spring. This is because strep throat infections occur more often in these seasons. Strep is contagious. This means it can be spread from person to person. But rheumatic fever is not contagious.
Rheumatic fever is an autoimmune reaction to the strep bacteria. An immune reaction is when the body attacks its own tissues. It can be prevented if strep throat is diagnosed right away and treated with antibiotics. Rheumatic fever is not common in the U.S.
Children ages 5 to 15 are most at risk for having rheumatic fever. They are most at risk if they:
- Have strep throat infections often
- Have strep infections that were untreated or not treated enough
- Have a family history of rheumatic fever
The symptoms usually start about 1 to 5 weeks after a child has been infected with strep bacteria. Each child’s symptoms may vary. Common symptoms can include:
- Inflammation in joints such as the knees or ankles that causes swelling, soreness, and redness
- Small, painless, hard bumps (nodules) under the skin, often over bony areas
- Unusual jerky movements, most often of the face and hands. This is often noted by a change in a child's handwriting.
- Red rash with odd edges on the torso, arms, or legs
- Weight loss
- Lack of energy (fatigue)
- Stomach pains
These symptoms can seem like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
Your child’s healthcare provider will take your child’s medical history and do a physical exam. Your child may also have tests such as:
- Blood tests. These are done to look for signs of inflammation, recent strep infection, and other related problems.
- Electrocardiogram (ECG). This is a test that records the electrical activity of the heart. It shows abnormal rhythms and detects heart muscle damage.
- Throat culture. A swab is wiped on the throat. This is done to look for the strep bacteria.
Your child's healthcare provider will look for:
- Inflammation of the heart
- Inflammation of more than 1 joint
- Unusual jerky movements
- Small, hard bumps under the skin
- Red, irregular rash
- Pain in 1 or more joints
- Previous inflammation of the heart
- Changes in the ECG pattern
- Abnormal sedimentation rate or C-reactive protein in blood tests
Children with rheumatic fever are often treated in the hospital. Your child's healthcare provider will figure out the best treatment plan for your child based on:
- How old your child is
- Your child’s overall health and medical history
- How sick your child is
- How well your child handles certain medicines, treatments, or therapies
- If your child’s condition is expected to get worse
- The opinion of the healthcare providers involved in your child's care
- Your opinion and preference
Treatment for rheumatic fever often combines the following 3 things:
- Treatment for strep. The first step is to treat the strep infection with antibiotics. This is done even if a throat culture is negative. Your child may need to take monthly doses of antibiotics. This is to help prevent other problems.
- Anti-inflammatory medicines. Your child may take medicines to help decrease the swelling that occurs in the heart muscle. These medicines also help ease joint pain.
- Bed rest. The length of bed rest will depend on how severe your child's illness is. Bed rest may range from 2 to 12 weeks.
Talk with your child’s healthcare provider about the risks, benefits, and possible side effects of all medicines.
If the illness severely attacks a child's heart, this may damage heart valves and cause heart disease. In this case, your child may not be allowed to do some kinds of physical activity and sports.
If the heart was damaged by the fever, your child will need to take special care when going to the dentist in the future. He or she may need to take antibiotics before having dental work done. This helps lower the chance of an infection traveling to the heart during a dental procedure. Talk with your child's healthcare provider for more information.
Many cases of rheumatic fever may be prevented by quickly treating strep throat with antibiotics.
Having rheumatic fever increases your child's chances of having the disease again. This is at highest risk during the first 3 years. The chance of having the disease again lessens with age and time.
After having rheumatic fever, your child will need to take antibiotics every month. These are to help lessen the chance of having rheumatic fever again. Often by the time a child is 18, the antibiotic therapy may be stopped. Close follow-up with your child's healthcare provider is needed.
Call the healthcare provider if your child's symptoms get worse or there are new symptoms.
- Rheumatic fever is a complex disease that affects the joints, skin, heart, blood vessels, and brain.
- It may occur after an infection with strep bacteria, such as strep throat or scarlet fever.
- Symptoms may include joint inflammation, small hard bumps under the skin, jerky movements, a rash, and fever.
- Treatment includes antibiotics, anti-inflammatory medicine, and bed rest.
- Your child will need to have ongoing treatment to stop the disease from coming back.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
January 16, 2018
Horowitz, Diane, MD , Brown, Kim, APRN