Rheumatic Fever

What is rheumatic fever?

Rheumatic fever is a rare autoimmune disease that causes inflammation of your child’s tissues and organs. Healthcare providers also call it acute rheumatic fever. The condition occurs when your child’s immune system overreacts to an untreated strep throat or scarlet fever infection.

Strep throat and scarlet fever are both bacterial infections caused by group A Streptococcus. If your child doesn’t receive treatment for these infections, their immune system may attack its own tissues. This can cause swelling and inflammation that may affect your child’s joints, heart and blood vessels.

Scarlet fever vs. rheumatic fever

Scarlet fever and strep throat are group A Streptococcus infections. A type of bacteria called group A Streptococcus causes both infections. Healthcare providers treat them with antibiotics.

Rheumatic fever is a very rare complication of scarlet fever and strep throat. It can happen when one of these infections goes untreated.

How common is rheumatic fever?

While strep infections are common in the United States, rheumatic fever isn’t. Because antibiotics are widely available in the U.S., most people get treatment for strep throat and scarlet fever. Clearing up these conditions prevents rheumatic fever.

Rheumatic fever happens more often in places with limited resources, such as resource-poor countries. But it can occur in the U.S., especially in areas with limited access to medical care.

What are the symptoms of rheumatic fever?

Rheumatic fever can affect people in different ways. Sometimes, people have such mild strep they don’t realize they had an infection until rheumatic fever develops later on.

Rheumatic fever causes many symptoms that look similar to other health issues. Most of these other conditions are routine and not dangerous. Symptoms can vary widely depending on what part of your child’s body the disease impacts. Because rheumatic fever can be serious, always call your child’s healthcare provider if you suspect they may have the condition.

One common symptom of rheumatic fever is a rash. The rash may be flat and red with irregular edges. Other common rheumatic fever symptoms include:

• Swollen, tender and red joints (arthritis) — especially your child’s knees, ankles and elbows — that may move around from day to day.
• Jerky movements your child can’t control in their hands, feet or other body parts (chorea).
• Small bumps (nodules) under your child’s skin.
• Chest pain or abnormal heartbeat.
• Feeling overly tired all the time (fatigue).
• Fever.
• Unexplained or ongoing headaches, especially if your child has never complained of head pain before.
• Muscle aches.
• Swollen, red tonsils.

What causes rheumatic fever?

Rheumatic fever is an overreaction of your child’s immune system that causes it to fight healthy tissues. An untreated strep throat or scarlet fever infection can trigger this overreaction. It happens when your child doesn’t receive antibiotic treatment for group A Streptococcus infections.

When your body’s defenses (antibodies) begin to fight back, the reaction can damage healthy tissues and organs instead of the bacteria.

Who gets rheumatic fever?

Anyone can get rheumatic fever. But it mostly affects children and teenagers (ages 5 to 15). Rheumatic fever usually develops two to three weeks after an untreated strep throat or scarlet fever infection. Rheumatic fever generally doesn’t occur in children younger than 5 and older than 15.

How often does strep throat or scarlet fever cause rheumatic fever?

Most people who get strep throat or scarlet fever don’t develop rheumatic fever. It only happens when children don’t receive treatment for the infections. Even then, rheumatic fever is exceedingly rare in the U.S.

Who’s at risk for rheumatic fever?

Certain factors can increase your risk of getting rheumatic fever:

• Where you live: Most people with rheumatic fever live in places that have limited medical resources, such as resource-poor countries. Living in an area where it’s difficult to get medication or medical care may also put your child at risk.
• Age: Rheumatic fever mostly affects children or teenagers between the ages of 5 and 15.
• Overall health: Having a weakened immune system can increase your child’s risk. Children who frequently get strep infections may be more likely to get rheumatic fever.
• Family history: If someone in your family has had rheumatic fever, other family members may be more likely to get it.
• Crowded areas: Bacteria spread more easily in places where large groups gather.

Can adults get rheumatic fever?

It’s very rare, but adults can also get rheumatic fever.

Is rheumatic fever contagious?

Rheumatic fever isn’t contagious. You can’t give it to or get it from someone else. But strep throat and scarlet fever are contagious. These infections spread through respiratory droplets (by coughing or sneezing on someone else).

How does rheumatic fever affect the heart?

Rheumatic fever doesn’t always affect the heart. But when it does, it can damage heart tissues, especially the heart valves. Scarred heart tissue doesn’t work correctly. Over time, rheumatic fever may lead to permanent heart damage. Providers may call this condition rheumatic heart disease or congestive heart failure.

If rheumatic fever injures a heart valve, your child’s provider may recommend surgery to repair or replace the affected valve. Heart damage may show up 10 to 20 years after a rheumatic fever diagnosis. It’s important to stay in regular contact with a healthcare provider you trust.

Can rheumatic fever cause rheumatoid arthritis?

Rheumatic fever has similar early symptoms to rheumatoid arthritis (RA), but the two conditions aren’t related. Both conditions may affect your child’s joints, but rheumatic fever usually lasts only a few weeks, whereas RA is a lifelong disorder. Children under age 16 are diagnosed with juvenile idiopathic arthritis, not rheumatoid arthritis.

How is rheumatic fever diagnosed?

If your child has had a sore throat for more than a couple of days, reach out to their healthcare provider. Treating a group A streptococcal infection can prevent rheumatic fever.

If their provider suspects rheumatic fever, they’ll first swab your child’s throat to check for group A Streptococcus bacteria. They may use a rapid strep test or order a throat culture.

A rapid strep test can provide results within 10 minutes. A throat culture takes a few days to get results. However, rapid strep tests sometimes give false-negative results (saying you don’t have strep when you really do).

What other tests will be done to diagnose rheumatic fever?

Depending on your symptoms, your child’s healthcare provider may also order:

• Blood tests: Sometimes, providers order a blood test to confirm a strep infection. Blood tests can detect antibodies (your body’s defenses against the bacteria) when the bacteria no longer show up on tests. Other blood tests check for substances (like proteins) that show inflammation in your child’s body.
• Heart tests: Heart tests help providers check your child’s heart function. These may include an electrocardiogram (EKG) or an echocardiogram (ultrasound of the heart, also known as an echo).

What are the Jones criteria for rheumatic fever?

Healthcare providers sometimes use the Jones criteria to diagnose rheumatic fever. To make a diagnosis of rheumatic fever, your child must have two major criteria or one major and two minor criteria from the following lists. In addition, there must be laboratory evidence of a previous group A streptococcal infection.

Major criteria include:

• Arthritis of several joints.
• Heart inflammation (carditis).
• Bumps (nodules) under their skin.
• Rapid, jerky movements (chorea).
• Skin rash (erythema marginatum).

Minor criteria include:

• Fever.
• Elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels.
• Joint pain (arthralgia).
• EKG (electrocardiogram) changes.
• History of previous rheumatic fever or rheumatic heart disease.

How is rheumatic fever treated?

Rheumatic fever treatment first focuses on getting rid of the bacterial infection. Treatments then address inflammation inside your child’s body.

Treatment for rheumatic fever may include:

• Antibiotics: Healthcare providers prescribe antibiotics to treat the underlying bacterial infection. Some antibiotics are one injection (shot). Others your child takes by mouth for a week or more.
• Anti-inflammatory medications: Your child’s provider will likely recommend a medication to reduce inflammation throughout your child’s body. This medication may also relieve symptoms such as joint pain. For severe symptoms, your child’s provider may prescribe a stronger medication (corticosteroids).
• Other therapies: Rheumatic fever can affect people in different ways. Your child’s provider may recommend other treatments based on how the condition affects them. In severe cases, your child may need heart surgery or joint treatments to treat serious complications.

How can I prevent rheumatic fever?

Treating strep throat and scarlet fever early is essential. It can prevent rheumatic fever. Strep throat and scarlet fever symptoms aren’t always obvious or easy to spot. Call your child’s healthcare provider for guidance if your child has had a sore throat for more than three days or has other symptoms that concern you.

If your child has strep throat or scarlet fever, make sure you follow their provider’s instructions carefully. Your child needs to finish the full course of antibiotics, even if they feel better. Otherwise, the infection may not go away and may make your child more prone to rheumatic fever.

What else can I do to protect against rheumatic fever?

Practicing good hygiene can reduce your child’s chances of getting a bacterial infection. It can also stop your child from spreading an infection to someone else. Your child should always:

• Wash their hands often (and well) with soap and water.
• Cough or sneeze into a tissue, their elbow or upper shoulder (not their hand).
• Use a tissue once for a sneeze or to blow their nose, then throw it away and wash their hands.

If your child’s been diagnosed with rheumatic fever, their provider may prescribe a long-term antibiotic (monthly injections of penicillin). This can help prevent future bouts of strep throat and prevent recurrences of rheumatic fever.

What’s the outlook for someone with rheumatic fever?

Rheumatic fever doesn’t have a cure, but treatments can manage the condition. Getting a precise diagnosis soon after symptoms show up can prevent the disease from causing permanent damage. Severe complications are rare. When they occur, they may affect your child’s heart, joints, nervous system or skin.

Rheumatic fever can come back or become a serious problem. In some cases, rheumatic fever can lead to serious or even life-threatening complications. Your child may need regular checkups to protect their health long-term.

Can rheumatic fever come back?

Yes. Your child can get rheumatic fever again if they get strep throat or scarlet fever again. If they’ve had rheumatic fever, their provider may recommend they take antibiotics for years or possibly throughout their life. This treatment is called antibiotic prophylaxis. It can prevent another strep infection and keep rheumatic fever from coming back.

What should I ask my child’s healthcare provider?

If your child has rheumatic fever, you may want to ask their provider:

• What antibiotic do you recommend?
• How long does my child need to take this medication?
• Will my child need to take antibiotics long-term?
• Will my child need other tests, now or in the future?
• How could rheumatic fever affect my child, now or in the future?
• Are there any activities that could pose a danger to my child’s health?
• What type of medical care will my child need moving forward?
• What can I do to best protect my child’s health?
• When should I call my child’s healthcare provider?

If you suspect your child may have strep throat or scarlet fever, don’t wait to call their provider. Early treatment can prevent rheumatic fever. Common signs of these bacterial infections include:

• A sore throat that lasts more than three days.
• A lack of appetite (especially if due to problems swallowing).
• Swollen lymph nodes on their neck.
• A red rash that feels like sandpaper.
• Fever.
• Swollen, red or spotted tonsils (glands in the back of their mouth).
• A headache.

A note from Cleveland Clinic

Rheumatic fever is a rare complication of untreated strep throat or scarlet fever. It most commonly affects children and teens. In severe cases, it can lead to serious health problems that affect your child’s heart, joints or other organs. If you suspect your child has strep or scarlet fever, take them in to see their provider right away. This can help prevent rheumatic fever. People with rheumatic fever often need lifelong medical care to protect their health.