Rheumatic Fever

Rheumatic fever, a complex inflammatory disease, can cause lasting damage to the heart if left untreated. This condition often starts with a strep throat infection and can progress to affect various parts of the body. Understanding rheumatic fever disease is crucial for early detection and proper care.

This article attempts to provide an in-depth understanding of rheumatic fever disease’s causes, symptoms, and treatment. We'll explore the signs to watch out for, the factors that increase the risk of developing this disease, and the potential complications it can cause. Additionally, we'll discuss how doctors diagnose rheumatic fever, the available treatment options, and steps to prevent its occurrence. 

What is Rheumatic Fever?

It is a serious inflammatory disease that can develop when strep throat or scarlet fever goes untreated. It occurs when the immune system overreacts to an infection by group A streptococcus bacteria. This overreaction tricks the body into attacking its healthy tissues, leading to inflammation in various body parts, including the heart, joints, skin, and brain. Rheumatic fever primarily affects children aged 5 to 15, typically developing 14 to 28 days after a strep infection. Although rare in developed countries, it remains a concern in some areas. The condition can have long-lasting effects, particularly on the heart, potentially causing damage to heart valves and even heart failure if left untreated.

Symptoms of Rheumatic Fever

Rheumatic fever symptoms typically appear 2 to 4 weeks after a strep throat infection. The condition causes inflammation in various body parts, leading to various symptoms. These can include: 

• Fever
• Joint pain 
• Swelling in joints, particularly in the knees, ankles, elbows, and wrists 
• Chest pain and abnormal heartbeat
• Fatigue
• Small painless bumps beneath the skin
• Flat or slightly raised rash with ragged edges
• Some individuals develop Sydenham chorea, characterised by jerky, uncontrollable body movements, especially in the hands, feet, and face. 

Rheumatic fever signs and symptoms can vary widely, come and go, or change during the illness. It's important to note that rheumatic fever can affect people differently, and some may have such mild strep infections that they don't realise they have one until rheumatic fever develops later.

Causes of Rheumatic Fever

Rheumatic fever develops as an abnormal immune response to untreated group A Streptococcus infections, primarily strep throat or scarlet fever. The condition occurs when the body's defence mechanisms mistakenly attack healthy tissues instead of the bacteria. This overreaction typically happens two to four weeks after an untreated streptococcal infection.

Risk Factors

Several factors increase the likelihood of developing rheumatic fever, including: 

• Living in overcrowded conditions, particularly in low- and middle-income countries with limited access to healthcare
• Having a weakened immune system
• Age also plays a role, with children and teenagers between 5 and 15 years old being most susceptible. 
• A family history of rheumatic fever
• Frequent strep infections can also contribute to a higher risk of rheumatic fever.
• Poor housing conditions, such as cold, damp, and mouldy environments
• Barriers to accessing primary healthcare, including the inability to book timely appointments or afford prescriptions, can delay the treatment of strep infections, potentially leading to rheumatic fever.

Complications

Rheumatic fever can lead to severe complications:

• The most significant long-term consequence is rheumatic heart disease, which causes permanent damage to heart valves. This damage can result in:
• Valve stenosis or regurgitation, potentially leading to heart failure, arrhythmias, and increased risk of stroke. 
  • Atrial fibrillation
  • Endocarditis
  • Pulmonary hypertension 
• In rare cases, rheumatic fever can affect the nervous system, causing Sydenham chorea, a condition characterised by involuntary movements. 
• Joint complications, such as Jaccoud arthropathy, may also occur, mainly affecting fingers, toes, and wrists. 
• Pregnant women with rheumatic heart disease face higher risks of adverse outcomes due to increased strain on the heart. 

Diagnosis of Rheumatic Fever

The diagnosis remains challenging due to the lack of specific clinical or laboratory findings, requiring careful consideration of symptoms and test results. Doctors rely on the revised Jones criteria, which include major and minor manifestations. To diagnose rheumatic fever, patients must have two major criteria or one major and two minor criteria, along with evidence of a recent streptococcal infection. 

Major criteria include:

• Carditis
• Arthritis
• Chorea
• Erythema marginatum
• Subcutaneous nodules

Minor criteria comprise: 

• Fever
• Elevated inflammatory markers
• Joint pain
• ECG changes
• Blood tests check for inflammation and streptococcal antibodies. 
• Heart tests, such as echocardiograms and electrocardiograms, assess cardiac function. 
• Echocardiography with Doppler is now recommended for all suspected cases to detect subclinical carditis. 

Treatment of Rheumatic Fever

The rheumatic fever treatment focuses on eradicating the bacterial infection and addressing inflammation. 

• Medication:
  • Doctors prescribe antibiotics, typically penicillin, to eliminate the streptococcal infection. 
  • Anti-inflammatory medicines to reduce inflammation and relieve symptoms like joint pain. 
  • In severe cases, doctors may prescribe corticosteroids. 
  • Secondary prevention involves long-term antibiotic prophylaxis to prevent recurrent attacks, with intramuscular penicillin being the preferred method due to its effectiveness and better compliance.
  • Treatment strategies also include managing the acute attack and preventing further infections. Doctors prescribe medications like digoxin, vasodilators, and diuretics for patients with heart complications. 
• Surgery: In extreme cases, heart surgery might be required to treat severe valve lesions. 

When to See a Doctor

• It's crucial to consult your doctor promptly if you or your child develops strep throat or scarlet fever symptoms. Early treatment of strep throat can prevent rheumatic fever. 
• Contact a clinician if you notice signs of strep throat, such as a sudden sore throat, swallowing pain, fever, headache, or stomach discomfort. These symptoms require careful medical evaluation, as several conditions share similar signs. 
• For children with a sore throat lasting more than a few days, it's advisable to contact a doctor. 

Remember, timely medical intervention is key to reducing the risk of developing rheumatic fever and its potential complications.

Prevention

Preventing rheumatic fever involves correctly identifying and adequately treating strep throat infections. Prompt action is crucial when symptoms arise. 

• If your child has a sore throat lasting over three days, consult a doctor immediately. Ensure your child completes the course of prescribed antibiotics, even if they feel better, to eliminate the infection. 
• Good hygiene practices are vital for prevention. Encourage frequent handwashing with soap, and teach children to cough or sneeze into a tissue or their elbow (in the absence of cloth or tissue). 
• Avoid sharing personal items with sick individuals. 

Long-term antibiotic prophylaxis may be recommended for those previously diagnosed with rheumatic fever to prevent recurrences and future strep infections.

Conclusion

Rheumatic fever has a significant impact on individuals, particularly children and teenagers, with potentially severe consequences for heart health. The condition's complexity, from its origins in untreated strep infections to its wide-ranging symptoms, underscores the importance of early detection and proper care. Understanding the risk factors and recognising the signs can be crucial in preventing long-term complications. By raising awareness about this condition & promoting good hygiene practices, we can work towards reducing its occurrence. Remember, a simple sore throat should never be ignored, as timely intervention can make a difference in preventing this serious inflammatory disease and its lasting effects on health.

FAQ's

1. How common is rheumatic fever?

Rheumatic fever has a significant impact on global health, with approximately 470,000 new cases occurring annually. It's rare in developed countries but remains common in areas with poverty and poor health systems. The disease burden is higher in developing countries due to untreated or inadequately treated strep infections. 

2. Is rheumatic fever curable?

While rheumatic fever itself can be treated, it may cause long-lasting heart damage. Treatment involves antibiotics to eliminate strep bacteria and prevent recurrence.

Anti-inflammatory medications help manage symptoms. Most people recover, but a small percentage may develop permanent heart damage. Long-term antibiotic prophylaxis can prevent future episodes.

3. What is rheumatic fever in a child?

Rheumatic fever primarily affects children aged 5 to 15, typically appearing 2 to 4 weeks after a strep throat infection. It's an autoimmune reaction causing inflammation in various body parts, including joints, heart, skin, and brain. Symptoms may include joint pain, fever, chest pain, and involuntary movements.

4. Is rheumatic disease curable?

Rheumatic fever, an inflammatory disorder, can be treated but may lead to long-term complications, particularly rheumatic heart disease. While the acute phase can be managed with antibiotics and anti-inflammatory medications, some patients may experience lasting effects on their heart valves. Regular check-ups are essential, as heart damage might not appear for years or even decades after the initial infection.

5. What foods are bad for rheumatoid arthritis?

Although rheumatoid arthritis differs from rheumatic fever, certain foods may exacerbate inflammation in both conditions. These include:

• Grilled, broiled, or fried meats
• Foods high in trans fats
• Sugars and refined carbohydrates
• Foods with preservatives and flavour enhancers
• Excessive alcohol

6. Is rheumatic fever painful?

Rheumatic fever can cause significant pain, particularly in the joints. Arthritis or arthralgias are often the earliest manifestations in 60% to 80% of rheumatic fever patients. The pain typically affects large joints like knees, ankles, or wrists and can be migratory. Additionally, some patients may experience chest pain due to heart inflammation. The severity of pain can vary among individuals.

7. When does rheumatic fever start?

Rheumatic fever typically begins 2 to 4 weeks after an untreated strep throat infection. However, some cases may develop as early as one week or as late as five weeks after the initial infection. The onset of symptoms can be gradual or sudden.

Dr. Gandham Sneha

MBBS, DNB (Internal Medicine)
CARE Hospitals Outpatient Centre, Banjara Hills, Hyderabad

To Book an Appointment, call:

+91 406 810 6585