Rheumatic Fever

Joint pain and fever are the most common first symptoms. One or several joints suddenly become painful and feel tender when touched. They may also be warm, swollen, and red. Joints may be stiff and may contain fluid. Ankles, knees, elbows, and wrists are usually affected. The shoulders, hips, and small joints of the hands and feet also may be affected. As pain in one joint lessens, pain in another joint starts (called migratory pain).

Joint pains may be mild or severe and typically last about 2 weeks and rarely more than 4 weeks.

Rheumatic fever does not cause long-term joint damage.

Some children with heart inflammation have no symptoms, and the inflammation is recognized years later when heart damage is discovered. Some children feel their heart beating rapidly. Other children have chest pain caused by inflammation of the sac around the heart (pericarditis Acute Pericarditis Acute pericarditis is inflammation of the pericardium (the flexible two-layered sac that envelops the heart) that begins suddenly, is often painful, and causes fluid and blood components such... read more ). Children may have a high fever, chest pain, or both.

Heart murmurs are sounds that occur as blood flows through the heart. Children commonly have quiet heart murmurs. However, murmurs that are loud or have changed sometimes mean the child has a heart valve disorder Overview of Heart Valve Disorders Heart valves regulate the flow of blood through the heart's four chambers—two small, round upper chambers (atria) and two larger, cone-shaped lower chambers (ventricles). Each ventricle has... read more . When rheumatic fever involves the heart, the heart valves are commonly affected, which causes the development of new, larger, or different murmurs that doctors can hear using a stethoscope.

Heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more may develop, causing the child to feel tired and short of breath, with nausea, vomiting, stomachache, and a hacking, nonproductive cough.

Heart inflammation disappears gradually, usually within 5 months. However, it may permanently damage the heart valves, resulting in rheumatic heart disease. The likelihood of developing rheumatic heart disease varies with the severity of the initial heart inflammation and also depends on whether recurring streptococcal infections are treated.

In rheumatic heart disease, the valve between the left atrium and ventricle (mitral valve) is most commonly damaged. The valve may become leaky (mitral valve regurgitation Mitral Regurgitation Mitral regurgitation is leakage of blood backward through the mitral valve each time the left ventricle contracts. Disorders directly affecting the mitral valve and heart attack are the most... read more ), abnormally narrow (mitral valve stenosis Mitral Stenosis Mitral stenosis is a narrowing of the mitral valve opening that blocks (obstructs) blood flow from the left atrium to the left ventricle. Mitral stenosis usually results from rheumatic fever... read more ), or both. Valve damage causes the characteristic heart murmurs that enable a doctor to diagnose rheumatic fever. Later in life, usually in middle age, the valve damage may cause heart failure and atrial fibrillation Atrial Fibrillation and Atrial Flutter Atrial fibrillation and atrial flutter are very fast electrical discharge patterns that make the atria (upper chambers of the heart) contract very rapidly, with some of the electrical impulses... read more (an abnormal heart rhythm).

A flat, painless rash with a wavy edge (erythema marginatum) may appear as the other symptoms subside. It lasts for only a short time, sometimes less than a day.

Small, hard, painless lumps (nodules) may form under the skin in children with heart or joint inflammation. The nodules typically appear near the affected joints and go away after a while.

Jerky, uncontrollable movements, usually of both arms and legs and particularly of the face, feet, and hands, called Sydenham chorea may begin gradually in children with rheumatic fever but usually only after all other symptoms have subsided. A month may go by before the jerky movements become so intense that the child is taken to a doctor. By then, the child typically has rapid, purposeless, sporadic movements that disappear during sleep. The movements may involve any muscle except those of the eyes. They may begin in the hands and spread to the feet and face. Facial grimacing (a distorted expression on the face) is common. Children may cluck their tongue, or the tongue may dart in and out of the mouth.

In mild cases, children may seem clumsy and may have slight difficulties in dressing and eating. In severe cases, children may have to be protected from injuring themselves with their flailing arms or legs. The chorea lasts between 4 months and 8 months.

The best way to prevent rheumatic fever is with prompt and complete antibiotic treatment of any streptococcal throat infection.

In addition, children who have had rheumatic fever should be given drugs (typically penicillin) by mouth every day or by monthly injections into the muscle to help prevent another streptococcal infection. When antibiotics are given to people who do not yet have an infection, this preventive treatment is called prophylaxis. How long this preventive treatment should be continued is unclear. It depends on the severity of the disease and is usually continued for at least 5 years or until age 21 (whichever is longer). Some doctors recommend that it should be continued for life in certain people, such as those who have lasting heart valve damage and have close contact with young children (because the children may carry streptococcal bacteria, which could reinfect such people).