An Overview of Rheumatic Fever

Symptoms, Treatment, and Complications

Sick woman taking her temperature
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Rheumatic fever, a serious illness that can follow strep throat, is a widespread inflammatory condition that can affect various parts of the body, including the skin, joints, brain, and heart. Rheumatic fever is seen almost exclusively in children and adolescents.

The Cause of Rheumatic Fever

Rheumatic fever is an autoimmune disorder. It is triggered by the body's immune response to group A beta hemolytic strep (GABHS), the bacterium that produces strep throat.

In rheumatic fever, the antibodies the body produces to fight the strep infection can become "confused," and begin attacking various organs within the body.

The most serious complication of rheumatic fever is an inflammation of the heart (called carditis), which can lead to rheumatic heart disease. Rheumatic heart disease often leaves the patient with chronic valvular heart disease, especially mitral stenosis, mitral regurgitation, and aortic stenosis, and aortic regurgitation.

While rheumatic fever was very common in the United States 100 years ago (and in fact was a leading cause of death in young people), it is now quite rare in developed countries. The reduction in rheumatic fever is thought to be due to the aggressive treatment of suspected strep throat with antibiotics. Rheumatic fever remains a major problem, however, in undeveloped countries.

Symptoms of Rheumatic Fever

Symptoms of rheumatic fever can include:

  • Fever, headache, weakness, weight loss, sweating, and other general signs of illness
  • Joint pain that moves from joint to joint (so-called "migratory" joint pain)
  • Chest pain suggestive of pericarditis
  • Personality changes, especially irritability and short attention span

Doctors will diagnose rheumatic fever if you have: a) at least one of the symptoms listed above, b) blood tests or a throat culture that indicate recent infection with GABHS, and c) at least one of the following signs:

  • Carditis (this can be either pericarditis, inflammation of the heart muscle, or inflammation of the heart valves)
  • Arthritis involving more than one joint
  • Chorea (a distinctive, writhing movement disorder)
  • Bumps under the skin (subcutaneous nodules)
  • Erythema marginatum (a distinctive rash)

Treatment of Rheumatic Fever

Anyone diagnosed with acute rheumatic fever should be treated aggressively. Treatment includes:

  • A course of antibiotics to get rid of any GABHS that may be provoking an ongoing immune response
  • Anti-inflammatory medicines including aspirin (which in high doses usually produces a dramatic response in rheumatic fever), and possibly steroid therapy (especially if carditis is present)
  • Treatment with antibiotics (at least until age 21) to prevent recurrences of rheumatic fever. This is called prophylactic antibiotic therapy. (Here are the American Heart Association's recommendations on prophylaxis for rheumatic fever.)

Long-term Risks After Rheumatic Fever

Once acute rheumatic fever has resolved, the long-term risks are almost completely related to the risk of developing chronic rheumatic heart disease. Anyone who has had rheumatic fever has an increased risk of developing it again if exposed to GABHS, so it is critical to follow recommendations for prophylactic antibiotics.

People who have recovered from rheumatic fever ought to have a baseline cardiac evaluation, including an echocardiogram. Annual re-evaluations should be done, consisting at least of a physical examination, to see if any new heart murmurs have appeared (which might indicate that rheumatic heart disease is present). If the physical examination suggests a change, then a repeat echocardiogram should​ be performed determine whether rheumatic valvular disease may be developing.


Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. JAMA 1992; 268:2069.

Tibazarwa KB, Volmink JA, Mayosi BM. Incidence of acute rheumatic fever in the world: a systematic review of population-based studies. Heart 2008; 94:1534.

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