RHEUMATIC FEVER

Rheumatic fever is a complex inflammatory condition that can develop as a complication of untreated or inadequately treated strep throat caused by group A Streptococcus bacteria.

Symptoms usually manifest a few weeks after having strep throat and may include fever, muscle aches, swollen and painful joints, and sometimes a red rash. In some cases, the initial strep infection may have been too mild to notice.

The joints most commonly affected by rheumatic fever are the knees, ankles, elbows, and wrists. The pain can migrate from one joint to another. However, the most significant risk associated with the disease is the damage it can inflict on the heart. More than half of the time, it affects the heart valves, forcing the heart to work harder to pump blood. Over time, this damage can progress to rheumatic heart disease, a serious condition that can ultimately lead to heart failure.

Additionally, rheumatic fever can trigger a temporary nervous system disorder called Sydenham’s chorea, previously known as St. Vitus’ dance. This disorder causes rapid, jerky movements of the body, usually on one side. Mild cases may make it difficult to concentrate or write, while severe cases can result in uncontrollable twitching in the arms, legs, or face, along with muscle weakness and emotional outbursts.

Thanks to antibiotics, rheumatic fever is now rare in developed countries. However, there has been a recent increase in cases in the U.S., particularly among children in disadvantaged urban areas. The illness tends to occur more frequently in cool, damp weather during winter and early spring, and it’s most prevalent in the northern states of the U.S.

Causes

Rheumatic fever occurs when the body’s immune system mistakenly attacks its own tissues, specifically the heart, joints, skin, and brain, following an untreated streptococcal infection. The exact mechanisms underlying this autoimmune response are not fully understood, but it is believed to involve molecular mimicry, where proteins produced by the streptococcal bacteria resemble proteins found in the body’s own tissues. This triggers an immune response that can lead to inflammation and tissue damage. Only a tiny fraction of individuals who contract strep throat, less than 0.3%, develop rheumatic fever. Experts suspect that additional factors, such as a weakened immune system, may contribute to this occurrence. Furthermore, failure to treat a scarlet fever infection can also result in rheumatic fever.

Comparison with Scarlet Fever

Scarlet fever is a highly contagious and typically mild bacterial illness characterized by fever, sore throat, and a rash. It is linked to rheumatic fever in several ways. Both stem from the same group A streptococcus bacteria. Furthermore, untreated scarlet fever can lead to rheumatic fever. While scarlet fever can be transmitted from person to person, rheumatic fever itself is not contagious.

Symptoms of Rheumatic Fever

The symptoms can vary widely and may affect different parts of the body. Common symptoms include:

Fever
Joint pain and swelling, often migrating from one joint to another
Chest pain
Shortness of breath
Fatigue
Skin rash
Jerky, involuntary movements (Sydenham’s chorea)
Abdominal pain

Risk Factors

Several factors can increase the risk of developing this type of fever:

Age: Children and adolescents are at higher risk, especially between the ages of 5 and 15.
Untreated Strep Throat: Failure to promptly treat strep throat with antibiotics increases the likelihood of developing rheumatic fever.
Genetic Predisposition: Some individuals may have a genetic susceptibility to developing rheumatic fever.
Socioeconomic Factors: Poor access to healthcare and living in crowded or unsanitary conditions may increase the risk.

Prevalence

Rheumatic fever remains prevalent in low-income and developing countries, particularly in areas with limited access to healthcare and inadequate antibiotic treatment for strep throat. However, cases have declined significantly in developed countries where streptococcal infections are promptly treated with antibiotics.

Diagnosis

Diagnosing this type of fever can be challenging due to its varied symptoms and the absence of specific diagnostic tests. Healthcare providers typically rely on a combination of clinical assessment, medical history, physical examination, and laboratory tests. Diagnostic criteria established by the Jones criteria help guide the diagnosis and classification of rheumatic fever.

Treatment of Rheumatic Fever

The primary goals of treating this type of fever are to alleviate symptoms, eradicate the underlying streptococcal infection, and prevent complications. Treatment may include:

Antibiotics: High-dose antibiotics, such as penicillin or amoxicillin, are prescribed to eradicate the streptococcal bacteria.
Anti-inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen or corticosteroids may be used to reduce to alleviate swelling and discomfort.
Bed Rest: Rest is essential during the acute phase of rheumatic fever to reduce strain on the heart and joints.
Symptom Management: Medications may be prescribed to manage specific symptoms, such as pain relievers for joint pain or anticonvulsants for chorea.

Home Care Remedies

While medical treatment is essential for managing this fever, certain home care remedies can help alleviate symptoms and support recovery. These may include:

Rest: Adequate rest is crucial for promoting healing and reducing strain on the body.
Pain Management: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help alleviate joint pain and fever.
Hydration: Drinking plenty of fluids helps maintain hydration and supports overall health.
Warm Compresses: Applying warm compresses to swollen joints can help reduce pain and inflammation.

Prevention of Rheumatic Fever

Preventing this fever primarily involves prompt treatment of streptococcal infections with antibiotics. Other preventive measures include:

Good Hygiene: Practicing good hand hygiene and avoiding close contact with individuals who have strep throat can reduce the risk of infection.
Antibiotic Prophylaxis: Individuals with a history of rheumatic fever or certain heart conditions may require long-term antibiotic prophylaxis to prevent recurrent streptococcal infections.

Complications of Rheumatic Fever

Even weeks or months after recovering from this type of fever, some individuals may still experience joint and tissue swelling, which could lead to long-term health issues for certain people. Additionally, rheumatic heart disease typically develops years after the initial illness, but heart valve damage can occur even while symptoms are present.

Heart damage from this type of fever may include:

Valve Stenosis: This condition involves the narrowing of a heart valve, restricting blood flow through the valve.
Valve Regurgitation: When a heart valve fails to close properly, blood may flow backward across the valve, causing regurgitation.
Heart Muscle Damage: Swelling resulting from rheumatic fever can damage the heart muscle, affecting its ability to pump blood effectively.
Irregular Heartbeat (Atrial Fibrillation): Damage to the heart valves and other cardiac structures can lead to an irregular heartbeat known as atrial fibrillation (AFib).

When to See a Doctor

It is essential to seek medical attention if you or your child experience symptoms of strep throat, such as sore throat, fever, and swollen lymph nodes. Prompt treatment with antibiotics can help prevent complications such as rheumatic fever.

Outlook/Prognosis

With early diagnosis and appropriate treatment, the prognosis for this type of fever is generally favorable. Most individuals recover completely within a few weeks to months with proper medical care. However, without treatment, this type of fever can lead to serious complications, including rheumatic heart disease, which can cause permanent damage to the heart valves and increase the risk of heart failure.

In conclusion, this fever is a potentially serious condition that requires prompt medical attention and appropriate treatment to prevent complications and promote recovery.

Sources

American Heart Association. (2015). Rheumatic Fever.
Centers for Disease Control and Prevention. (2020). Rheumatic Fever.
World Health Organization. (2004). Rheumatic Fever and Rheumatic Heart Disease.
Carapetis, J. R., Steer, A. C., Mulholland, E. K., & Weber, M. (2005). The global burden of group A streptococcal diseases. The Lancet Infectious Diseases, 5(11), 685-694.
Mayo Clinic: Rheumatic fever.”