What is Rheumatic Fever?

Pediatric Basics

father checking his daughter for a fever
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Rheumatic fever is actually a complication of an infection, like strep throat, and not an infection itself. Although rheumatic fever used to be a major cause of heart disease in children, it is fortunately not very common anymore.

Still, because strep throat is so common, it is a good idea to learn to recognize the symptoms of rheumatic fever and understand how it is diagnosed and treated.

Symptoms of Rheumatic Fever

Children with rheumatic fever usually have a recent untreated upper respiratory strep infection and then a 1 to 5 weeks later they develop some combination of the following symptoms (major manifestations):

  • Migratory Polyarthritis: usually the most common symptom is arthritis (joint inflammation) that involves the larger joints of the body, especially the knees, ankles, wrists, and elbows, and which lasts a few days before moving to another joint.
  • Carditis: occurs in about half of affected children and is heart disease that can cause a fast heart rate (tachycardia), heart murmurs, and heart failure, and can lead to long-term complications.
  • Chorea: uncontrollable movements and other more subtle neurological problems.
  • Erythema Marginatum: a characteristic rash that is actually uncommon in kids with rheumatic fever.
  • Subcutaneous Nodules: firm nodules under the skin.

Other signs and symptoms, which are considered minor manifestations of rheumatic fever, can include arthralgia (joint pain without any swelling or signs of arthritis), fever, elevated blood tests, including a CRP or ESR, and first-degree heart block.


Diagnosis of Rheumatic Fever

Unfortunately, there is no single test to help doctors figure out if a child has rheumatic fever. Instead, they use the Jones criteria, which states that a child likely has rheumatic fever if they have evidence of a recent group A streptococcal infection and:

  • two major manifestations
  • one major and two minor manifestations

Diagnosing rheumatic fever can still be difficult, though, and it is often confused with juvenile rheumatoid arthritis (JRA), systemic lupus erythematosus, serum sickness, leukemia, Lyme disease, and viral infections.

Also, your doctor might consider exceptions to the Jones criteria in some specific situations.

Since arthritis is the most common and usually the most obvious symptom, children with rheumatic fever often see a pediatric rheumatologist as they are getting evaluated, especially if they don't have symptoms of heart disease that might lead to a diagnose of rheumatic fever.

Treatments of Rheumatic Fever

The treatment for rheumatic fever includes antibiotics to treat the original strep infection, supportive care, including bed rest, and anti-inflammatory medicines, such as salicylates and steroids.

Most of the symptoms of rheumatic fever go away over a matter of months, with only those kids with severe heart involvement usually having lasting symptoms.

What You Need To Know About Rheumatic Fever

  • Rheumatic fever is thought to develop either because certain rheumatologic strains of group A streptococcal bacteria release a toxin that damages cells or because of some kind of immunologic cross-reaction between the bacteria and our cells.
  • Testing for a recent strep infection usually includes blood antibody tests, including the antistreptolysin O (ASO), anti-DNase B, and an antihyaluronidase test.
  • Kids with rheumatic fever usually take antibiotics every day so that they don't get another strep infection, which can trigger another episode of rheumatic fever (long-term antibiotic prophylaxis).
  • Antibiotics are required before dental procedures (endocarditis prophylaxis) if a child had rheumatic fever and it affected their heart valves.
  • Treating group A streptococcal infections, like strep throat, with antibiotics before the ninth day of symptoms usually prevents the child from getting rheumatic fever.
  • Kids who develop rheumatic fever sometimes have a family history of rheumatic fever.
  • Although now rare in the United States and other industrials countries, rheumatic fever is still a big problem in the rest of the developing world.



Behrman: Nelson Textbook of Pediatrics, 17th ed.

Park: Pediatric Cardiology for Practitioners, 4th ed.

Gershon: Krugman's Infectious Diseases of Children, 11th ed.

Acute rheumatic fever: a chink in the chain that links the heart to the throat? McDonald M - Lancet Infect Dis - 01-APR-2004; 4(4): 240-5

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