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Overview
What Is Acute Rheumatic Fever?
Acute rheumatic fever is an inflammatory immune reaction that can occur after an untreated or inadequately treated group A streptococcal infection of the throat or skin. The immune system mistakenly attacks some of the body’s own tissues, causing inflammation. It most often affects school-age children and adolescents. Rheumatic fever can involve the heart, joints, skin, and nervous system.
Symptoms
Symptoms of Acute Rheumatic Fever
Symptoms of acute rheumatic fever can begin about 1–5 weeks after a group A streptococcal infection. They may range from mild to severe and can affect several body systems at the same time.
- Painful joints may move from one joint to another (migratory polyarthritis).
- Fever may develop and can be high.
- Chest discomfort may occur when inflammation affects the heart.
- Shortness of breath may signal heart involvement.
- A fast heartbeat may occur at rest or with little activity.
- Involuntary, jerky movements may occur (Sydenham chorea).
- Small, firm, painless bumps may appear under the skin (subcutaneous nodules).
- A non-itchy, ring-shaped rash may develop (erythema marginatum).
Important distinction
Rash needs clinical evaluation
A rash after a strep infection is not automatically rheumatic fever. A clinician must assess the complete pattern of symptoms, examination findings, and evidence of a recent infection.
Causes
What Causes Acute Rheumatic Fever?
Acute rheumatic fever usually develops 1–5 weeks after group A streptococcal pharyngitis, or less commonly after a skin infection. The body’s immune response to the infection can mistakenly react with its own tissues, causing inflammation in the heart, joints, skin, or nervous system. The condition is not usually caused by bacteria directly invading each affected organ.
Strep Throat, Scarlet Fever, and Rheumatic Fever
Strep throat is an active group A strep infection of the throat. Scarlet fever is a toxin-related illness that can occur during a group A strep infection, often causing a fine rash, whereas acute rheumatic fever is a delayed immune complication. Neither scarlet fever nor rheumatic fever should be self-diagnosed from a rash alone.
Risk Factors
Risk Factors for Acute Rheumatic Fever
- Children and adolescents ages 5–15 years have a higher risk.
- A previous episode of acute rheumatic fever increases the risk of another episode.
- Untreated or inadequately treated group A strep infection increases risk.
- Close-contact or crowded living conditions can increase exposure to group A strep.
- Limited access to timely healthcare can delay diagnosis and treatment.
- Living in a region where acute rheumatic fever is more common increases population-level risk.
Complications
Complications of Acute Rheumatic Fever
- Inflammation of the heart can occur (carditis).
- Heart valve damage may lead to chronic rheumatic heart disease.
- Heart failure can develop when cardiac inflammation is severe.
- Irregular heart rhythms may occur with heart involvement.
- Movement symptoms may persist for some time after the acute illness.
- Recurrent acute rheumatic fever can cause additional inflammation and damage.
Why follow-up matters
Preventing recurrence protects the heart
Repeated episodes can cause cumulative heart valve damage. After an episode, clinicians may prescribe preventive antibiotics and follow-up care to reduce the risk of recurrence.
Diagnosis
How Acute Rheumatic Fever Is Diagnosed
There is no single test that confirms acute rheumatic fever. Clinicians combine the medical history, physical examination, revised Jones criteria, and evidence of a recent group A streptococcal infection. They also assess whether the heart or other organs are involved.
How the Revised Jones Criteria Are Used
| Category | Examples to assess |
|---|---|
| Major manifestations | Carditis, arthritis, chorea, erythema marginatum, and subcutaneous nodules |
| Minor findings | Fever, joint pain, raised inflammatory markers, and a prolonged PR interval |
| Additional evidence | A recent group A streptococcal infection shown by testing or other clinical evidence |
- Throat testing or streptococcal antibody testing can look for a current or recent group A strep infection.
- Blood tests for inflammatory markers can show whether inflammation is present.
- Electrocardiography can assess heart rhythm and the PR interval.
- Echocardiography can evaluate carditis and heart valve function.
Treatment & Management
Treatment and Management of Acute Rheumatic Fever
TREAT THE PRECEDING INFECTION
A clinician-prescribed antibiotic is used to eradicate group A strep, even if the sore throat has already resolved. Taking it exactly as directed helps address the preceding infection and supports prevention of further complications.
CONTROL INFLAMMATION AND PROTECT THE HEART
Clinician-directed anti-inflammatory treatment can reduce pain and inflammation, with activity guidance based on the person’s condition. Severe carditis or heart failure may require specialist care, additional medicines, and close monitoring.
Long-Term Antibiotic Prevention and Follow-Up
Many patients need scheduled secondary antibiotic prophylaxis for years, with the duration individualized according to cardiac involvement and specialist guidance. Follow-up examinations and echocardiograms may be needed to monitor heart inflammation or valve changes. This rheumatic fever treatment plan is designed to reduce the risk of another episode.
Prevention
Preventing Acute Rheumatic Fever
- Seek medical evaluation for suspected strep throat or a compatible skin infection.
- Complete every prescribed antibiotic course, even if symptoms improve.
- Do not share antibiotics or use someone else’s medication.
- Practice hand hygiene and cover coughs and sneezes to reduce respiratory spread.
- Follow the prescribed secondary antibiotic prophylaxis schedule after an acute rheumatic fever diagnosis.
Prevention focus
Treat suspected strep promptly
There is no routine screening test for people without symptoms. Prevention depends on prompt clinical care for suspected group A strep infection and adherence to prescribed treatment and prophylaxis.
Outlook and Prognosis
Outlook and Prognosis
Many symptoms of acute rheumatic fever improve with treatment, but heart inflammation or valve damage may require prolonged monitoring and specialist care. The long-term outlook varies depending on whether the heart was affected and whether repeat episodes occur.
- The severity of carditis can affect recovery and long-term heart health.
- Heart valve involvement increases the risk of lasting rheumatic heart disease.
- Recurrent episodes can cause additional valve damage.
- Adherence to preventive antibiotics lowers the risk of recurrence.
- Access to regular follow-up care supports early detection and management of heart problems.
When Should You See a Doctor
When Should You See a Doctor?
Seek medical care
Evaluation after strep
Seek prompt medical assessment for fever, painful or swollen migrating joints, unusual movements, a rash, chest pain, shortness of breath, fainting, or a racing heartbeat occurring weeks after suspected or confirmed strep infection.
Symptoms
1 topic
Acute Rheumatic Fever
Fever
