What Is Rheumatic Fever?
Acute rheumatic fever is a condition that affects mostly children, although people of all ages can manifest it. It is a generalized inflammatory disease that arises as a sequelae of an infection with a bacteria known as Streptococcus (group A). It is known as an “autoimmune” condition because the body’s immune system is responsible for the tissue injury that occurs in acute rheumatic fever.
Rheumatic fever is usually preventable and is, therefore, quite rare. It is also treatable, but it can lead to some very severe outcomes.
1. Etiology
Acute rheumatic fever is a sequelae of an infection caused by the streptococcus (group A) bacterium. These bacteria are one of the most common causes of bacterial acute sore throat or pharyngitis (strep throat or scarlet fever), as well as other skin infections like cellulitis and impetigo. For some people with these strep infections, the body’s immune system gets confused when reacting to them, and becomes unable to distinguish between the host tissues and the invading pathogen. This results in tissue injury that is not caused by the bacteria, but by the body itself. As you will soon read, this explains why acute rheumatic fever can cause generalized inflammation, especially of the heart, blood vessels and joints.
If treatment for the initial bacterial infection is not provided promptly, in a minority of patients, this disease can develop two to four weeks later. Fortunately, treatment of both strep throat and scarlet fever is fairly straightforward. Antibiotics are usually all that is needed, and the patient will usually be ill for only a few days or so. Acute rheumatic disease is a potentially very serious condition, however, so it is always wise not to take strep throat or scarlet fever lightly.
2. Who Gets It?
Rheumatic fever can affect people of any age. However, it most commonly affects children from the ages of 5 to 15 years old. This is partly because children tend to stay close together in fairly large groups when at school or home, enabling streptococcal infections to spread easier.
Rheumatic fever is quite rare in developed countries. This is because of good hygiene practices and ready access to medical care and primary prevention. Where these are not prevalent, strep infections are more likely to be missed and go untreated. Thus, people living in developing nations are at greater risk of developing rheumatic fever.
3. Permanent Damage
While most illnesses will pass in a few days with no permanent damage done, others can leave serious long-term sequelae. If rheumatic fever is not treated in time, then it can cause permanent damage to the heart.
The symptoms will vary from person to person, and the symptoms are likely to arise around two to four weeks from the onset of a strep throat infection. Some people are fortunate to have only a few relatively mild symptoms. Others, however, will have considerably worse symptoms. Regardless of how severe the symptoms might be; the patient should always receive medical attention if rheumatic fever is suspected.
4. Sore Throat
As mentioned above, roughly half of the patients with this condition report experiencing respiratory symptoms several weeks before the onset of the disease.
If the appropriate antibiotic is prescribed and administered at this time, the risk of developing acute rheumatic fever is reduced by almost eighty percent. Remember that antibiotic treatment for bacterial pharyngitis should only be prescribed by a professional after confirmation with a throat culture or rapid antigen detection tests.
5. Pain in Joints
Perhaps one of the most characteristic symptoms of rheumatic fever is a pain in the joints. This is caused by the inflammation of multiple joints at a time, also known as polyarthritis. The pain tends to be experienced in large joints like the ankles, elbows, knees, and wrists.
In addition, patients with rheumatic fever will also find that these joints can exhibit swelling, redness, warmth, and tenderness. What’s more, is that pain will often be migratory. This means that it will be experienced in one joint first, but then, sometimes even before it has subsided in the initial site, it will move onto another joint. These manifestations usually subside within a few weeks and disappear completely after 2-6 weeks.
6. Nodules under Skin
Rarely, patients will develop small painless bumps just under the skin. These bumps, known as subcutaneous nodules, will be found around the ankles, elbows, knees, knuckles, vertebrae, and scalp.
They can be as large as 2 cm in size, but are often smaller; thus, they often go unnoticed by the patient. These subcutaneous nodules will only persist for around two weeks. Finally, they are associated with severe carditis or inflammation of heart tissues.
7. Rash
Another rare manifestation of acute rheumatic fever is a painless rash, known as erythema marginatum. It presents with redness of the skin in the form of round lesions. These tend to advance at the margins while clearing the center; thus, resembling smoke rings. It appears usually on the trunk of the body and the extremities, and commonly goes unnoticed by patients.
While many rashes are harmless in themselves, they can be a sign of a disease, so it is a good idea to check with a doctor if you are unsure.
8. Chest Pain
Chest pain is another symptom associated with rheumatic fever. It occurs in patients that develop acute carditis, which is the inflammation (and possible damage) of any or all of the layers of the heart, including the heart valves. Carditis is most common in children and occurs in roughly 30 to 60 percent of the first episodes of acute rheumatic fever. In this condition, chest pain may be accompanied by shortness of breath and cough; however, carditis can also be subclinical or asymptomatic.
Importantly, this inflammation of the heart tissues has the potential to cause long-term disability or death. While acute rheumatic fever leaves no lasting damage to other parts of the body, damage to the heart valves may persist once the carditis has resolved (i.e. rheumatic heart disease). Thus, the importance of primary prevention of this condition.
9. Sydenham Chorea
Another rare manifestation of acute rheumatic fever is known as Sydenham chorea. Chorea is a neurological disorder defined by the presence of involuntary, uncontrollable, random, and continuous movements of any part of the body. This disorder usually involves the face, tongue, and extremities (often worse on one side of the body). Other manifestations of Sydenham chorea include muscle weakness (i.e. difficulty maintaining a steady hand grip), slurred speech, personality changes, and emotional lability.
Symptoms of Sydenham chorea usually resolve within 3 weeks to 6 months. Nevertheless, for some patients, symptoms may last longer than one year.
10. Treatment
As always, the best cure is prevention, and this is very much the case with acute rheumatic fever. It can usually be prevented by ensuring that cases of strep throat or scarlet fever are treated accordingly as soon as the condition is diagnosed.
If rheumatic fever does ensue, anti-inflammatory agents are used to improve most symptoms (i.e. arthritis, fever). In patients with acute carditis, bed rest is advised and several therapeutic measures are available. Finally, for patients with Sydenham chorea, a non stimulatory environment is advised, while certain drugs might be warranted to control the symptoms.
