What is Rheumatic Fever?
Rheumatic fever is an inflammatory disease affecting different areas of the body such as joints, the nervous system and heart.
It arises following infection with a bacteria from the group A streptococcus. This bacteria is known for initiating diseases such as strep throat and scarlet fever. (1)
Not everyone with a streptococcus infection will go on to develop this inflammatory disease. Precisely how this bacteria causes rheumatic fever remains inconclusive. (2)
Of those affected by an untreated infection strep bacteria infection, about five percent will develop rheumatic fever. In contrast to strep throat and scarlet fever, this disease is not contagious. (3)
Research into the condition has shown a possible hereditary connection. Some people might have a specific genetic makeup making them susceptible to rheumatic fever.
If the condition is not treated, could lead to serious complications such as heart damage.
Rheumatic fever is primarily diagnosed in children and young adults, being most prevalent between the ages of six and 16. It generally develops 14 to 28 days following an infection such as strep throat or scarlet fever. Symptoms can include the following:
Rheumatic fever will affect the different systems in the body, leading to autoimmune responses. These are likely to trigger an increase in core temperature as a reaction to the infection. (4)
Despite the name of the condition, fever is among the less severe symptoms of this condition. However, it may come in bouts until the infection has cleared.
Those affected by rheumatic fever are inclined to experience nosebleeds during the illness. (5)
The small blood vessels inside the nose become very vulnerable and are easy targets for trauma. They may break when sneezing or blowing the nose. This is thought to be a result of autoimmune defenses. The veins enlarge to make room for antibody cells to reach the infection. (6)
Rheumatic fever is very likely to manifest with abdominal pain. People affected may exhibit tenderness across the stomach as a reaction to the overall inflammatory process. (7)
Joint Pain and Swelling
One of the primary effects rheumatic fever can have on the body involves the joints.
People with this disease may encounter joint pain and swelling in and around the joints. It might even evolve to arthritis which is more severe inflammation. If so, the affected areas may appear red and warm. (8)
This symptom will generally affect the joints in the knees, elbows, ankles or wrists. However, it may begin in one location and spread to another.
The pain can be mild or severe, depending on the person. In older children and young adults the pain can be quite serious. It will usually come in episodes that may last for up to a few days. Fortunately, it’s likely to subside within a week or so.
Small nodules or bulges formed of fatty tissues may emerge. These are especially prevalent around the bony areas, such as the elbows. They will typically develop three or four at a time and may persist for a couple of weeks. (9)
The skin is likely to become pink or slightly red in color. Little red spots will appear that will expand outwards, usually in a creeping pattern, creating a ring-shaped rash. The middle will lose its color and look significantly pale. (10)
These rashes are generally noticed on the chest and back, but may also grow on the legs and arms.
Rheumatic fever can affect the functions of the brain. Sometimes, the affected can display emotional disturbances or instability. He/she may enter episodes of spontaneous crying or laughter. The person can also exhibit restlessness or signs of obsessive-compulsive disorder (OCD). (11)
Chorea, sometimes called Sydenham’s chorea or St. Vitus’s dance, is a condition in which parts of the body will make impulsive, quick jerks. These are very likely to occur in the face. The affected may illustrate grimaces, grins or frowns. (12)
Rheumatic fever remains a mysterious disease. Experts have found connections in genetic makeup with untreated strep bacteria infections. Exactly how it develops is yet to be understood. (13)
However, what is better understood is how the condition gives rise to complications. If this disease is left untreated or is recurrent, it may advance into rheumatic heart disease or neurological damage. (14)
Rheumatic Heart Disease
This development will weaken the heart and could eventually lead to heart failure and become a permanent complication. It will damage different parts such as the valves, linings and the muscle itself. Symptoms may not always be apparent, but they can include general signs of heart problems such as, shortness of breath and chest pains. (15)
It occurs as cells in the heart collide with antibody cells fighting against the immune system. This collision will cause an attack on the outer lining of a heart valve.
The reaction will result in an inflammatory response in the different parts of the heart. Swelling will occur and eventually cells will absorb excess fluids. This will lead to an abnormal growth, thus creating scar tissues.
This process will then repeat itself. The antibodies recognize other protein cells and initiate another attack. These reactions will continue to recur, further damaging the heart.
This condition is another complication if rheumatic fever remains untreated or has an acute onset. (16)
Antibody cells will attack the nervous system, damaging the linings. The result is impairments of neurological processes. The patient may begin to exhibit changes in handwriting. Quick, uncontrollable movements, generally in the face, and loss of fine motor skills usually follow.
As the damage continues, psychological changes will take place, such as loss of emotional control and behavioral issues. The affected may burst out in laughter for no apparent reason, or display unprovoked sadness.
If these attacks are left untreated, they may eventually lead to a mental disorder called psychosis. This will meddle with thoughts and emotions to such extent that the affected might lose touch with reality. (17)
There is no particular test which will show a precise result of rheumatic fever. Doctors will typically base the diagnosis on a physical examination and a symptom questionnaire. (18)
If these should indicate rheumatic fever, blood samples will be examined to check for the presence of the strep bacteria. Further testing can include chest X-rays and echocardiogram.
When a diagnosis is established, a treatment plan will be prescribed.
Doctors will generally treat rheumatic fever with rounds of antibiotics and anti-inflammatory drugs such as aspirin or corticosteroids. These will eliminate the bacteria and reduce the symptoms.
Antibiotics are prescribed even in severe cases. They may be needed for prolonged periods to prevent the bacteria from reinfecting the person. Parents are often advised to continue a low dose for a few years even if no symptoms present. (19)
What is rheumatic fever? Rheumatic fever is an illness causing inflammation in different parts of the body.
What are the signs of rheumatic fever? Initial symptoms can include nosebleeds, fever and abdominal pain. As the inflammation continues to spread, manifestations can involve arthritis-like signs. Other signs include changes in the skin, such as bulges or nodules, redness and ring-shaped rashes. If the illness progresses the affected may exhibit personality changes, behavioral issues and uncontrollable emotions.
How do you develop rheumatic fever? A person must first be infected with group A streptococcus bacteria. Secondly, experts believe that there needs to be an impairment in the genetic makeup, as not everyone goes on to acquire the disease and it is not contagious. There are specific risk factors which could increase the chances, such as poor living conditions, overcrowded places and insufficient access to medical care. (20, 21)
How are you diagnosed for rheumatic fever? Doctors usually begin with a physical examination and questions about the symptoms. This is generally followed by X-rays of the chest and an echocardiogram to check for heart damage. Blood samples might also be drawn to check for the bacteria.
What is the best treatment of rheumatic fever? Treatment is based on antibiotics and anti-inflammatory medication such as aspirin. These will be used to kill the bacteria. Once eliminated, symptoms generally subside.
What are the long term complications of rheumatic fever? Complications will depend on how much the disease affects the heart. If the destruction is severe, it could progress to rheumatic heart disease. Additionally, those affected have an increased chance of contracting the disease again. Recurrent episodes of rheumatic fever tend to result in significant heart damage. (22)
Is rheumatic disease considered a disability? It can lead to brief mental disabilities, but these symptoms generally subside once treatment is initiated. (23)
Is there any cure for rheumatic fever? The bacteria can be eliminated and the person will generally feel better. However, there are chances of reinfection. Doctors will usually prescribe prolonged periods of low doses of antibiotics for children, to prevent a recurrent episode.
Is rheumatic fever life threatening? Yes, it can lead to heart damage which can be fatal.
Rheumatic fever is an inflammatory disease. It might occur following strep bacteria infections such as strep throat or scarlet fever.
Rheumatic fever will cause an inflammatory response in various parts of the body. If left untreated it could progress to heart damage and neurological impairments. Little is yet understood of its exact causes, but fortunately, it can be treated.
In the developing world, it remains a predominant cause of preventable heart disease. Children are particularly prone to its complications. (24, 25)