Rheumatic fever is an inflammatory disease that can develop as a complication of inadequately treated strep throat or scarlet fever. Strep throat and scarlet fever are caused by an infection with group A streptococcus bacteria.
Rheumatic fever is most common in 5 to 15 year old children, though it can develop in younger children and adults. Although strep throat is common, rheumatic fever is rare in the United States and other developed countries. However, rheumatic fever remains common in many developing nations.
Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure. Treatments can reduce tissue damage from inflammation, lessen pain and other symptoms, and prevent the recurrence of rheumatic fever.
Sings and Symptoms of Rheumatic Fever:
Rheumatic fever signs and symptoms result from inflammation in the heart, joints, skin or central nervous system:
- Painful and tender joints — most often the ankles, knees, elbows or wrists; less often the shoulders, hips, hands and feet
- Pain in one joint that migrates to another joint
- Red, hot or swollen joints
- Small, painless nodules beneath the skin
- Chest pain
- Heart murmur
- Flat or slightly raised, painless rash with a ragged edge (erythema marginatum)
- Jerky, uncontrollable body movements (Sydenham chorea or St. Vitus’ dance) — most often in the hands, feet and face
- Outbursts of unusual behavior, such as crying or inappropriate laughing, that accompanies Sydenham chorea
Causes of Rheumatic Fever:
Rheumatic fever can occur after an infection of the throat with a bacterium called Streptococcus pyogenes, or group A streptococcus. Group A streptococcus infections of the throat cause strep throat or, less commonly, scarlet fever. Group A streptococcus infections of the skin or other parts of the body rarely trigger rheumatic fever.
The exact link between strep infection and rheumatic fever isn’t clear, but it appears that the bacterium “plays tricks” on the immune system. The strep bacterium contains a protein similar to one found in certain tissues of the body. Therefore, immune system cells that would normally target the bacterium may treat the body’s own tissues as if they were infectious agents — particularly tissues of the heart, joints, skin and central nervous system. This immune system reaction results in inflammation.
If your child receives prompt and complete treatment with an antibiotic to eliminate strep bacteria — in other words, taking all doses of the medication as prescribed — there’s little to no chance of developing rheumatic fever. If your child has one or more episodes of strep throat or scarlet fever that aren’t treated or not treated completely, he or she may — but won’t necessarily — develop rheumatic fever.
Treatment of Rheumatic Fever:
The management of acute rheumatic fever is geared toward the reduction of inflammation with anti-inflammatory medications such as aspirin or corticosteroids.
- Individuals with positive cultures for strep throat should also be treated with antibiotics.
- Aspirin is the drug of choice and should be given at high doses of 100 mg/kg/day. One should watch for side effects like gastritis and salicylate poisoning. In children and teenagers, the use of aspirin and aspirin-containing products can be associated with Reye’s syndrome, a serious and potentially deadly condition. The risks, benefits and alternative treatments must always be considered when administering aspirin and aspirin-containing products in children and teenagers.
- Ibuprofen for pain and discomfort and corticosteroids for moderate to severe inflammatory reactions manifested by rheumatic fever should be considered in children and teenagers.
- Steroids are reserved for cases where there is evidence of involvement of heart. The use of steroids may prevent further scarring of tissue and may prevent development of sequelae such as mitral stenosis.
- Monthly injections of long acting penicillin must be given for a period of five years in patients having one attack of rheumatic fever. If there is evidence of carditis, the length of therapy may be up to 40 years.
- Another important cornerstone in treating rheumatic fever includes the continual use of low-dose antibiotics (such as penicillin, sulfadiazine, or erythromycin) to prevent recurrence.