Rheumatic Fever: Understanding the Causes, Recognizing the Symptoms, and Protecting Your Heart Health

Rheumatic fever is a serious inflammatory condition that can develop following an untreated bacterial infection, particularly strep throat. While now rare in developed countries, it remains a significant health concern in many parts of the world. Rheumatic fever primarily affects children and can lead to long-lasting complications, especially related to heart health. Understanding the causes, symptoms, and preventive measures is crucial for safeguarding you and your loved ones. In this article, we'll provide a comprehensive overview of rheumatic fever, equipping you with the knowledge to recognise warning signs and take timely action. 

What is rheumatic fever? 

Rheumatic fever is an inflammatory condition following untreated strep throat, caused by group A Streptococcus. It triggers the immune system to attack healthy tissues, affecting the heart, joints, brain, and skin. Common in children aged 5-15, it can occur at any age, causing widespread inflammation. 

Scarlet fever vs. rheumatic fever 

Scarlet fever and rheumatic fever are both caused by the same bacteria—group A Streptococcus. However, they are distinct conditions. Scarlet fever is characterised by a bright red rash, sore throat, and high fever. If left untreated, it can potentially lead to the development of rheumatic fever, which is a more severe condition involving inflammation of the heart, joints, and other tissues. 

How common is rheumatic fever? 

The incidence of rheumatic fever has significantly declined in developed countries due to improved living conditions and the widespread use of antibiotics to treat strep throat. However, it remains a major health issue in developing nations, particularly in overcrowded areas with limited access to healthcare. According to the World Health Organisation, there are an estimated 470,000 new cases of rheumatic fever globally each year. 

What are the symptoms of rheumatic fever? 

The symptoms of rheumatic fever can vary from person to person and may include: 

• Fever 

• Painful, tender, and swollen joints (polyarthritis), often migrating from one joint to another 

• Chest pain or heart palpitations 

• Fatigue and weakness 

• Flat or slightly raised, painless rash with irregular edges (erythema marginatum) 

• Small, painless bumps beneath the skin (subcutaneous nodules) 

• Uncontrollable jerky movements, particularly of the face, feet, and hands (Sydenham's chorea) 

It's important to note that not everyone with rheumatic fever will experience all of these symptoms. If you or your child have recently had a strep infection and develop any of these signs, seek medical attention promptly. 

What causes rheumatic fever? 

Rheumatic fever occurs when the immune system reacts abnormally to a group A Streptococcus infection, like strep throat or scarlet fever. This response, triggered by molecular mimicry, mistakenly targets healthy tissues, causing inflammation in the heart, joints, skin, and brain. 

Who gets rheumatic fever? 

Rheumatic fever most commonly affects children between the ages of 5 and 15, although it can occur in younger children and adults as well. Those living in overcrowded conditions with limited access to medical care are at a higher risk of developing the condition. 

What are the risk factors for rheumatic fever? 

Several factors can increase the likelihood of developing rheumatic fever: 

1. Untreated or inadequately treated strep throat infections 
2. Family history of rheumatic fever 
3. Living in overcrowded or unsanitary conditions 
4. Malnutrition and weakened immune system 
5. Genetic susceptibility 
6. Exposure to certain strains of group A Streptococcus bacteria 

Identifying and addressing these risk factors is crucial for preventing rheumatic fever. If you or your child are at a higher risk, be vigilant about treating strep throat promptly and completely with antibiotics as prescribed by your healthcare provider. 

Is rheumatic fever contagious? 

Rheumatic fever itself is not contagious. However, the strep throat infection that can lead to rheumatic fever is highly contagious and can spread through close contact with an infected person, such as through respiratory droplets when coughing or sneezing. 

How does rheumatic fever affect the heart? 

One of the most serious complications of rheumatic fever is rheumatic heart disease, which occurs when the inflammation caused by the condition damages the heart valves. Over time, this damage can lead to scarring and narrowing of the valves, making it difficult for the heart to pump blood efficiently. Rheumatic heart disease can cause heart murmurs, chest pain, shortness of breath, and fatigue. In severe cases, it may lead to heart failure and the need for valve replacement surgery. 

Can rheumatic fever cause rheumatoid arthritis? 

No, rheumatic fever does not cause rheumatoid arthritis. Although both conditions involve joint inflammation, they are distinct disorders with different causes. Rheumatoid arthritis is a chronic autoimmune condition, while rheumatic fever is an acute inflammatory response to a bacterial infection. 

How is rheumatic fever diagnosed? 

Diagnosing rheumatic fever involves a comprehensive evaluation of symptoms, physical examination findings, and test results. Healthcare providers use the modified Jones criteria, which include major and minor criteria, to guide the diagnosis. Major criteria include carditis (heart inflammation), polyarthritis (joint inflammation), chorea (uncontrollable movements), erythema marginatum (rash), and subcutaneous nodules. Minor criteria include fever, arthralgia (joint pain), elevated inflammatory markers, and a prolonged PR interval on an electrocardiogram (ECG). 

What tests will be done to diagnose rheumatic fever? 

To diagnose rheumatic fever, your healthcare provider may recommend the following tests: 

1. Throat swab culture or rapid antigen test to detect group A Streptococcus bacteria 
2. Blood tests to measure inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) 
3. Electrocardiogram (ECG) to assess heart rhythm and conduction 
4. Echocardiogram to evaluate heart valve function and detect any damage 

These tests, along with a thorough clinical evaluation, help healthcare providers accurately diagnose rheumatic fever and determine the most appropriate treatment plan. 

How is rheumatic fever treated? 

Treatment for rheumatic fever focuses on managing symptoms, controlling inflammation, and preventing complications, particularly rheumatic heart disease. The mainstays of rheumatic fever treatment include: 

1. Antibiotics: Penicillin or similar antibiotics treat group A Streptococcus and prevent reinfections. 
2. Anti-inflammatory drugs: NSAIDs like aspirin or naproxen reduce fever and joint inflammation. 
3. Corticosteroids: Severe cases may require prednisone to control inflammation, especially in the heart. 
4. Anticonvulsants: Valproic acid or carbamazepine manages chorea (uncontrollable movements). 
5. Bed rest: Essential for recovery, particularly during the acute phase of illness. 

Long-term follow-up with a cardiologist is crucial to monitor for and manage any heart-related complications. 

How is rheumatic fever prevented? 

Preventing rheumatic fever primarily involves prompt diagnosis and complete treatment of strep throat infections with appropriate antibiotics. Other preventive measures include: 

• Practicing good hygiene, such as frequent handwashing 

• Avoiding close contact with individuals who have strep throat 

• Completing the full course of antibiotics as prescribed, even if symptoms improve 

• Regular follow-up with healthcare providers for those with a history of rheumatic fever 

What complications are associated with rheumatic fever? 

The most serious complication of rheumatic fever is rheumatic heart disease, which can lead to permanent heart valve damage, heart failure, and an increased risk of stroke. Other potential complications include: 

• Sydenham's chorea (uncontrollable movements) 

• Joint deformities 

• Neuropsychiatric disorders such as obsessive-compulsive disorder or attention deficit hyperactivity disorder 

What's the outlook for people with rheumatic fever? 

With prompt diagnosis and appropriate treatment, most people with rheumatic fever recover completely. However, some may develop long-term complications, particularly rheumatic heart disease, which requires lifelong monitoring and management. 

Can rheumatic fever come back? 

Yes, rheumatic fever can recur, especially if strep throat infections are not properly treated. Individuals who have had rheumatic fever are more susceptible to future episodes and require long-term antibiotic prophylaxis to prevent recurrences. 

Conclusion 

Rheumatic fever is a serious condition that can have long-lasting effects on heart health. By understanding the causes, symptoms, and preventive measures, you can take proactive steps to protect yourself and your loved ones. If you suspect that you or your child may have rheumatic fever, seek medical attention promptly. At Metropolis Healthcare, we offer comprehensive diagnostic services, including blood tests and imaging studies, to aid in the accurate diagnosis and management of rheumatic fever. Our team of skilled phlebotomists can conduct at-home sample collection for your convenience, and our state-of-the-art laboratories ensure reliable and timely results. Trust Metropolis Healthcare to be your partner in prioritising your health and well-being.