Rheumatic fever is a serious disease that can develop as the result of a previous illness that wasn't treated properly. Scarlet fever and strep throat are the most common conditions that can lead to rheumatic fever. Rheumatic fever involves inflammation and it comes about as a result of a group A streptococcal infection.
Definition & Facts
A rare disease in the United States, rheumatic fever most commonly occurs in children from the age of 5 to 15 years old. The disease is most commonly associated with developing nations where access to basic medicine is limited and infections spread more readily due to poor sanitation and overcrowding.
Rheumatic fever can cause great damage to various parts of the heart without proper treatment. Permanent damage to the heart is called rheumatic heart disease. These complications as a result of rheumatic fever could include atrial fibrillation, endocarditis and pericarditis as well as valvular heart diseases like aortic stenosis and mitral stenosis. Rheumatic fever can also cause severe pain, fever, tenderness in the joints, and other symptoms.
Symptoms & Complaints
- Pain in the ankles, knee pain, wrist pain, and elbow pain
- Tenderness in the shoulders, hands, hips, and feet
- Joint swelling, heat, redness
- Small nodules may form beneath the skin, but these nodules are usually not painful.
- Heart murmurs, fatigue, and excessive lethargy.
In some instances, a condition known as erythema marginatum may develop. This is essentially a painless rash with a jagged edge that may be either flat or slightly raised. It can cause a feeling that is very similar to what you might experience with a sunburn. People with rheumatic fever may also develop a complication called Sydenham's chorea which is a neurological disorder that causes jerky movements, mood changes, and laughing and crying at inappropriate times.
The onset of rheumatic fever generally starts after an infection of the throat with the bacteria group A streptococcus. It can occur as a result of strep infections that are not treated properly. Strep bacteria have a protein that is very similar to another protein found in our bodies. This causes the antibodies of the immune system which fight infection to attack the tissues in the body as if they were an infection that needs to be removed. The immune system targets the tissues of the heart, central nervous system, skin, and joints. The response of the immune system results in the inflammation characteristic of rheumatic fever.
Diagnosis & Tests
Testing for rheumatic fever is fairly straightforward and most of the tests are non-invasive. The doctor will start with a physical examination and will check for any inflammation in the joints as well as fever. The skin will also be examined to detect any bumps or rash on the skin. Since people afflicted with the disease will often have an abnormal heart rate, the doctor may also check the heart for signs of a murmur or muffled sound. Additionally, movement tests can help to detect problems with the central nervous system.
There are blood tests that are available, but if the individual was already diagnosed with a strep infection this might not provide any new information because the bacteria may not be present in the tissues or the blood by the time rheumatic fever sets in. Other tests that can indicate the presence of the disease include an electrocardiogram (EKG), to look for heart patterns that may indicate inflammation. An echocardiogram may also be used to give the doctor access to live images of the heart. This can show potential problems with the structure of the heart.
Treatment & Therapy
The primary goal of treatment is to get rid of the bacteria that caused rheumatic fever in the first place. Antibiotics can be used to remove any of the remaining bacteria in the body. The most commonly used antibiotics include amoxicillin, penicillin G benzathine, and penicillin V potassium. When the patient is allergic to penicillin, it's possible to use azithromycin, clarithromycin, or clindamycin. Depending on how far the disease has advanced, some patients are prescribed antibiotics for life.
The doctor may also recommend an anti-inflammatory treatment to help reduce inflammation, fever, and pain. In addition to aspirin, these could include nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen. In addition to medications, bed rest is also crucial.
In severe cases, corticosteroids may be prescribed when the heart is inflamed. Anticonvulsant medications may be required if the disease has reached an advanced stage and has caused Sydenham's chorea. Diuretics are also often used.
Long-term care is often required once the disease has been dealt with, and the exact protocols will depend on the individual's condition. Adults will need different remedies than children, and a complete long-term plan should be discussed with a doctor. The treatment could last a minimum of five years, and it usually continues until a child is at least 21 years old.
Prevention & Prophylaxis
Prevention is the best way to avoid serious complications, and this disease is highly preventable in first-world countries like the United States. If strep throat infections or scarlet fever are treated completely, then there should be no need to ever worry about rheumatic fever in the United States.
This is why it's important to bring one's child to the doctor at the first signs of a fever that persists for more than a day. Otherwise, the treatment for rheumatic fever can last years and severely impact the life of the child.