At a Glance:
1. What is acute rheumatic fever?
2. What causes acute rheumatic fever?
4. Who is at risk of having a rheumatic fever?
5. What consists of acute rheumatic fever symptoms?
7. What are the diagnostic criteria for rheumatic fever?
8. What is the most common complication of acute rheumatic fever?
9. How long does acute rheumatic fever last?
10. How is acute rheumatic fever treated?
11. Is acute rheumatic fever preventable?
12. What are the symptoms of rheumatic heart disease?
Acute rheumatic fever is an autoimmune multisystem inflammatory disease caused by a type of bacteria known as the Group A BETA HEMOLYTIC streptococcus (GAS). It is commonly known as strep bacteria. It usually occurs when a throat (strep throat) or skin infection (scarlet fever) caused by the strep bacteria is not treated properly with antibiotics.
Acute rheumatic fever generally affects children between 5 to 15 years of age, especially in developing countries.
Acute rheumatic fever can affect the heart, joints, brain and skin. Its effect on the heart is of particular concern, as it can lead to permanent valve damage and heart failure.
Acute rheumatic fever is an autoimmune disease, a condition where the body attacks its own cells, mistaking it as a foreign particle.
The bacterial cell wall protein share identity with certain tissues in our body (e.g. heart valve). The body’s immune system attacks its own tissues containing this protein, thinking it to be a bacterial protein. This triggers a reaction and results in inflammation of the tissues of the heart, joints, skin and the nervous system.
The chances of developing rheumatic fever remain high in those with a history of 1 or more episodes of Strep throat or scarlet fever which has not been treated appropriately. It usually develops 14-28 days after a Strep infection.
It is rare in children who receive appropriate antibiotic treatment for Strep bacteria.
No, rheumatic fever is not contagious.
It is due to an individual’s immune response and is not an infection. However, people with strep throat or scarlet fever can spread the bacteria to others through respiratory droplets.
Some people are at higher risk of suffering from acute rheumatic fever as compared to others due to the following factors of
The classical acute rheumatic fever symptoms include fever and pain in the joints. However, symptoms may vary from one person to another and also change during the course of the disease.
Symptoms occur as a result of inflammation in the heart, joints, skin and central nervous system and can include
There is no single and specific test available currently to confirm rheumatic fever diagnosis. The doctor will need a complete medical history, conduct a physical examination and order some laboratory tests to confirm the disease. Tests may include
Diagnostic criteria for rheumatic fever are set of clinical features and laboratory findings in a patient which help the doctor to confirm the diagnosis.
The first rheumatic fever diagnostic criteria were developed by a scientist named Jones in 1944. It was later modified by the American Heart Association in 1992. The latest rheumatic fever Jones criteria have been published in 2015.
You can have an idea of the Jones criteria by looking at the below table. However, its exact interpretation can be done only by a clinician. The major criteria include the main clinical presentation whereas the minor criteria comprise of other clinical presentation and laboratory tests.
2015 Revised Jones criteria rheumatic fever
Major criteria | |
Low risk population | High risk population |
Carditis (clinical or subclinical) | Carditis (clinical or subclinical) |
Arthritis- only polyarthritis | Arthritis- monoarthritis or polyarthritis |
Chorea | Chorea |
Erythema marginatum | Erythema marginatum |
Subcutaneous nodules | Subcutaneous nodules |
Minor criteria | |
Low risk population | High risk population |
Polyarthralgia | Monoarthralgia |
Hyperpyrexia (≥38.5°C) | Hyperpyrexia (≥38°C) |
ESR ≥ 60mm/h and/or CRP ≥ 3.0 mg/dl | ESR ≥ 30mm/h and/or CRP ≥ 3.0 mg/dl |
Prolonged PR interval (after taking into account the differences related to age; if there is no carditis as a major criterion) | Prolonged PR interval (after taking into account the differences related to age; if there is no carditis as a major criterion) |
The most common complication of rheumatic fever includes rheumatic heart disease. It is a condition that can result in permanent heart damage.
Acute rheumatic fever does not cause any long-lasting damage to the brain, joints or skin, except for the heart.
Recurrent strep infections and acute rheumatic fever can further worsen rheumatic heart disease. Though heart complications usually occur after 10-20 years after Strep infection, it may occur within days in case of serious infection.
Heart complications can arise due to the following conditions
The above changes can increase the risk of heart conditions such as
An acute episode can last from about 6 weeks to more than 6 months.
The goals of acute rheumatic fever treatment include eliminating GAS bacteria, relieve symptoms of fever and pain, control inflammation and prevent future risk of re-infection.
Treatment primarily consists of:
The only way to prevent acute rheumatic fever is to treat Strep throat or scarlet fever appropriately and promptly with prescribed antibiotics.
It is advisable to seek medical help in case of the following symptoms of:
There may be no symptoms for many years. Symptoms usually depend on the heart valve affected and the severity of the damage. Patients may suffer from the following symptoms of
The above symptoms along with some tests can help the doctor to establish the diagnosis
Tests generally include
Mild valve leakage may not require any treatment. However, surgery may be needed if the valve leakage is severe enough to affect heart functioning.
Surgery can involve either repair of the damaged valve or replacement with an artificial valve, depending upon the severity of the damage.
Acute rheumatic fever is an autoimmune disease, a condition marked by fever and severe pain and inflammation of the joints. It is caused by Group A streptococcus (GAS), commonly known as the strep bacteria. It usually occurs when a throat (strep throat) or skin infection (scarlet fever) caused by the strep bacteria is not treated timely and appropriately with antibiotics.
Acute rheumatic fever generally affects children between 5 to 15 years of age, especially in developing countries. An acute episode can last from about 6 weeks to more than 6 months.
The most serious complication of acute rheumatic fever is rheumatic heart disease. This heart condition is characterised by damaged valves and increased risk of heart failure and atrial fibrillation.
Clinical examination by doctor and blood tests along with ECG, 2D Echo and Chest X-ray are the cornerstone of diagnosis. The Jones Criteria is widely used by medical practitioners to establish the diagnosis in suspected patients.
The only way to prevent acute rheumatic fever is to treat Strep throat or scarlet fever appropriately and promptly with prescribed antibiotics.
About Author –
Dr. Sunitha Kayidhi, Consultant Rheumatologist, Yashoda Hospitals – Hyderabad
MD (Internal medicine), DM (Rheumatology)
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