How to Identify Rheumatic Fever Symptoms

Comprehensive Guide to Rheumatic Fever: Symptoms & Treatment

A group A streptococcal (GAS) throat infection, most commonly strep throat, can result in rheumatic fever. It is a complicated autoimmune reaction, and timely diagnosis of this condition ensures the chance of successful treatment, particularly in children and adolescents. Therefore, it is essential to recognize rheumatic fever symptoms and comprehend its underlying causes.

Read on to get a deeper understanding of rheumatic fever, its causes, symptoms, risk factors, diagnosis, and treatment methods!

What is Rheumatic Fever?

Rheumatic fever is an inflammatory disease caused due to complications related to untreated or inadequately treated strep throat or scarlet fever. Both these conditions are caused by group A Streptococcus bacterium.

Widespread inflammation results from the body's immune system mistakenly attacking its own tissues in response to the infection, especially in the heart, joints, skin, and central nervous system. Although it mainly affects kids between the ages of 5 and 15, you can also notice rheumatic fever symptoms in adults and younger kids.

How to Identify Rheumatic Fever Symptoms?

Symptoms of rheumatic fever usually appear after two to four weeks of a strep throat infection. Since this illness can impact several organ systems, the presentation can vary greatly. However, the common signs include the following:

• Fever can be present, but the diagnosis of rheumatic fever relies more heavily on specific major symptoms like joint inflammation, heart involvement, and specific neurological or skin changes.
• Joint pain and swelling typically affect large joints like the knees, ankles, elbows, and wrists. With migratory arthritis, the pain may move from one joint to another.
• Heart inflammation (carditis) is the cause of chest pain or discomfort, which can have major consequences.
• Weaknessand general fatigue are noticed very often.
• Skin changes include small, painless bumps under the skin (subcutaneous nodules) and a flat or slightly elevated, ragged-edged, painless rash (erythema marginatum).
• Neurological symptoms such as Sydenham chorea, characterized by quick, uncontrollable movements, emotional outbursts, or behavioral abnormalities, can occur in certain patients.

Additional rheumatic fever signs and symptoms include the following:

• Palpitations
• Shortness of breath
• Heart failure symptoms in extreme situations.

Throughout the illness, symptoms may appear and disappear or change. Some patients may only have a few symptoms, and not all patients will experience them.

What Causes Rheumatic Fever?

Here is an overview of the causes of rheumatic fever:

• Rheumatic fever is triggered by an abnormal immune response to a throat infection caused by group A Streptococcus bacterium.
• In some individuals, the immune system mistakenly attacks healthy tissues while fighting the bacteria, particularly in the heart, joints, skin, and nervous system.
• This autoimmune reaction is the root cause of the inflammation and damage seen in rheumatic fever.
• The risk of developing rheumatic fever increases if strep throat or scarlet fever is not promptly or properly treated with antibiotics.
• The precise reason why only some people develop rheumatic fever after a strep infection is not fully understood, but genetic and environmental factors are believed to play a role.

What are the Risk Factors of Rheumatic Fever?

Several factors can increase the likelihood of developing rheumatic fever:

• Most common in children aged 5 to 15.
• History of strep throat or scarlet fever, especially if untreated or inadequately treated.
• Genetic predisposition may exist, as rheumatic fever sometimes runs in families.
• Overcrowded or unhygienicenvironments increase the risk of strep infections and, consequently, rheumatic fever.
• Limited access to healthcare and delays in diagnosing and treating strep infections raise the risk.

How to Diagnose Rheumatic Fever?

Diagnosing rheumatic fever can be challenging, as no definitive test exists. Instead, doctors assess a combination of clinical criteria, laboratory findings, and evidence of a recent strep infection:

1. Throat Swab Tests : If rheumatic fever is suspected, the first step is to check for a recent group A Streptococcus infection. A throat swab is taken to perform either a rapid test for strep, which gives results in about 10 minutes, or a throat culture, which takes several days but is more accurate. Rapid strep tests can sometimes miss the infections, so a throat culture is often used to confirm negative results.
2. Blood Tests : Blood tests help confirm a strep infection by detecting antibodies against the bacteria, even if the bacteria are no longer present. Additional blood tests measure markers of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are typically elevated in rheumatic fever.
3. Heart Tests : To evaluate heart involvement, doctors may order an electrocardiogram (EKG/ECG) to assess heart rhythm and look for signs of inflammation. An echocardiogram (ultrasound of the heart) provides images of the heart’s structure and function, helping to detect valve or tissue damage.
4. Jones Criteria : The diagnosis is formally made using the Jones Criteria, which require evidence of a preceding strep infection plus the fulfillment of one of two conditions: two major criteria or one major and two minor criteria.

What are the Treatment Methods for Rheumatic Fever?

Currently, there is no cure for rheumatic fever, but early and comprehensive treatment can manage symptoms, prevent complications, and reduce the risk of recurrence. They may include:

• Antibiotics : The first step is eradicating any remaining group A strep bacteria, usually with penicillin or another antibiotic. Long-term antibiotic prophylaxis may be prescribed to prevent recurrence, sometimes continuing for years, mainly if heart involvement occurs.
• Anti-inflammatory Medications : Aspirin or naproxen is commonly used to reduce inflammation, pain, and fever. In severe cases, corticosteroids may be prescribed.
• Other Medications : Anticonvulsant medications may be used if involuntary movements (Sydenham chorea) are severe.
• Bed Rest : Reducing cardiac stress during the acute phase is recommended, especially if there is heart involvement.
• Ongoing Monitoring : Regular follow-up is essential to detect and manage potential complications, particularly heart-related issues.

Overall, treatment depends on the severity of rheumatic fever symptoms and organ involvement. It is a rare but serious complication of untreated strep throat or scarlet fever, mainly affecting children and teens. If not managed, it can cause lasting heart, joint, or organ damage. Prompt treatment of strep infections and regular medical care is vital to prevent rheumatic fever and protect long-term health.