Rheumatic fever only develops after a person has had a strep infection, which causes symptoms such as:
- Muscle aches
- Red and swollen tonsils
- Sore throat
If you have a sore throat and fever for more than 24 hours or have a severe sore throat without much fever or other cold symptoms - especially if you've been exposed to someone with a strep infection - you should see your doctor. Rheumatic fever is easier to prevent than treat.
Prompt treatment of a strep infection can prevent the development of rheumatic fever. In more than half of all cases, rheumatic fever may affect the heart valves (rheumatic carditis) and interfere with normal blood flow through the heart.
Even without treatment, though, only about three people out of every 10 who have a strep throat infection develop rheumatic fever. The signs of rheumatic fever usually appear about five weeks after the strep infection.
Symptoms of rheumatic fever are divided into major and minor ones. A doctor will make a diagnosis of rheumatic fever if:
- Two major signs are present, or
- One major and two minor signs are present in person who has had a strep infection
The major symptoms are:
- Inflammation (swelling) of your heart. About half the time people have a first attack of rheumatic fever, they develop this. If this happens, you may feel weak, short of breath or have chest pain. A physical examination or a test such as an electrocardiogram or chest X-ray may also indicate inflammation of the heart. The inflammation may not lead to permanent damage, but it can lead to scarring of the heart valves and damage severe enough to cause heart failure. Sometimes the damage isn't diagnosed until years after the rheumatic fever has gone away.
- Pain that moves from joint to joint. This usually affects your ankles, wrists, knees and elbows. This can cause painful swelling, redness and a feeling of heat
- A lack of coordination or uncontrollable jerky movements of your arms, legs and face. Your handwriting may become worse, for example. This symptom is known as chorea, Sydenham's chorea, rheumatic chorea or St. Vitus' dance. About one out of every 10 people who have rheumatic fever develops this. It usually disappears in a few weeks or months.
- Pink or faint red rashy patches that don't itch on your skin
- Lumps under the skin, even if the rash isn't there
The minor symptoms include:
- A blood test indicating inflammation
- Abnormal heartbeat on an electrocardiogram
- Heart murmurs that hadn't been present before
- Joint pain without inflammation
- Previous rheumatic fever or evidence of rheumatic heart disease
Causes and Risk Factors
It is not yet known what causes rheumatic fever. It appears that when some people's bodies fight off a strep throat infection, other parts of the body develop inflammation (swelling and tenderness). Research has focused on whether this is an abnormal response by the immune system to the antigens produced by some types of streptococcal bacteria. The possibility that some people have a genetic disposition to have this response is also being studied.
Your risk of developing rheumatic fever is greater if you are:
- Between the ages of 6 and 15 years
- A woman. The disease is twice as common in women as it is in men.
- In a situation where you have a greater chance of being exposed to streptococcus infections such as in a developing country where there is not enough food, overcrowding and poverty
- While it is relatively rare in the United States, there have been outbreaks over the last 20 years that tended to occur in white, middle class suburban neighborhoods or in rural areas. Additionally, more aggressive strains of streptococci appear to be returning to the United States.