Rheumatic Fever
What is it?
Rheumatic fever is an inflammatory disease that arises
as a complication of untreated or inadequately treated
strep throat infection. This disorder usually occurs in
young school-age children and may affect the brain, heart,
joints or skin.
Who gets it?
Children between the ages of five and fifteen are most
susceptible to strep throat, and therefore most
susceptible to rheumatic fever. Other risk factors include
poverty, overcrowding, and lack of access to good medical
care.
What causes it?
Research suggests that rheumatic fever is caused by the
body’s immune system acting inappropriately as a
complication of strep throat. The body’s immune cells are
unable to distinguish between Group A streptococcus
bacteria’s antigens and antigens present on the body’s own
cells, resulting in the immune cells attacking the body.
However, some people develop rheumatic fever that never
had an obvious throat infection and test negative after a
throat culture.
What are the symptoms?
In addition to fever, another common symptom of the
disease is arthritis of the ankles, knees elbows and
wrists. The joints become red, hot, swollen, shiny and
extraordinarily painful. The patient may experience a
change in coordination, often first noted by changes in
handwriting, and the arms or legs may flail or jerk
uncontrollably. This symptom of rheumatic fever is called
Sydenham's chorea or St. Vitus' Dance. A number of skin
changes are common to rheumatic fever including a rash and
small bumps occurring under the skin.
The most serious problem occurring in rheumatic fever
is called pancarditis, an inflammation that affects all
aspects of the heart, including the lining of the heart (endocardium),
the sac containing the heart (pericardium), and the heart
muscle itself (myocardium). About 40-80% of all rheumatic
fever patients develop pancarditis. This complication has
the most serious, long-term effects because the valves
within the heart are frequently damaged.
How is it diagnosed?
Diagnosis of rheumatic fever is done by taking a sample
of the patient’s blood to test it for antibodies to the
streptococcus germs. A record of the patient’s heart's
activity, called an electrocardiogram, may show changes
from the normal pattern. In addition, an ultrasound test
called an echocardiogram may help diagnose valve problems.
What is the treatment?
Penicillin is the first line of treatment for rheumatic
fever, and patients will often need to remain on some
regular dose of penicillin to prevent recurrence.
Arthritis as a result of rheumatic fever can be treated
with aspirin or ibuprofen. Mild carditis will also improve
with such anti-inflammatory agents, although more severe
cases of carditis will require steroid medications. A
number of medications are available to treat the
involuntary movements of chorea, including diazepam for
mild cases, and haloperidol for more severe cases.
Self-care tips
A patient’s long-term health depends on how severely
the heart has been affected by the disease. It is very
important to prevent recurrences of rheumatic fever
because of the possibility of permanent heart damage.
Prevention of rheumatic fever recurrence requires
continued antibiotic treatment, perhaps for life. Patients
with existing rheumatic fever heart disease should always
take a special course of antibiotics when he or she
undergoes any kind of procedure (even dental cleanings)
that might allow bacteria to gain access to the
bloodstream.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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