Rheumatic Fever: Symptoms, Causes, Treatment

Not every painful joint represents rheumatic fever. It may appear weeks after streptococcal infection, which the patient may not clearly recall. The infection can spread between people, but the rheumatic inflammatory reaction itself is not contagious.

Related reading: Is a throat swab or a blood test used to diagnose strep throat?.

Features may include fever and painful inflammation moving between large joints, palpitations or breathlessness. Involuntary movements, rash or nodules can occur. Presentations vary, and heart involvement may not be obvious from symptoms alone.

An immune response after streptococcal infection causes inflammation. Throat infection is an established link, and guidance also addresses streptococcal skin infection. Not every infection progresses to rheumatic fever; unexplained joint pain alone does not justify antibiotics.

First episodes commonly affect school-age children and adolescents; a previous episode increases recurrence risk. Crowding and limited access to timely assessment and treatment contribute. Age alone does not exclude the diagnosis.

Diagnosis uses clinical criteria with appropriate evidence of prior streptococcal infection, while recognizing particular exceptions. Assessment may include echocardiography, ECG, inflammatory markers and antibody tests. An elevated streptococcal antibody result alone does not establish rheumatic fever.

Treatment clears streptococcal infection, controls inflammation and addresses cardiac involvement. Long-term preventive antibiotics reduce recurrence, with the plan based on age, cardiac disease and history. A single injection schedule or duration does not suit every patient.

Carditis can leave valve damage, called rheumatic heart disease, with possible later heart failure or rhythm problems. Recurrent episodes may worsen damage, making prevention and follow-up important after the initial symptoms improve.

Appropriate diagnosis and treatment of streptococcal infection, adherence to prescribed antibiotics and infection-control measures support prevention. After rheumatic fever, maintain prophylaxis and follow-up even when pain resolves. Viral sore throats do not routinely require antibiotics.