Rheumatic fever: symptoms, treatment and outlook

The NHS says symptoms of rheumatic fever usually appear 1 to 5 weeks after a bacterial throat infection. Patient.info describes the typical pattern as a bad sore throat followed, a few weeks later, by sore joints that come and go.

• A high temperature.

• Pain and swelling in the joints (arthritis), usually the ankles, knees, wrists or elbows. The joints may look red, though this may be less obvious on brown or black skin.

• Chest pain, breathlessness and a fast heart rate.

• Jerky, uncontrollable movements in the hands, feet and face (chorea).

• Tiny bumps under the skin.

• Pale-red patches on the arms and tummy, which may be harder to see on brown or black skin.

The NHS describes rheumatic fever as a very rare complication that can develop after a bacterial throat infection, which mainly affects children and can cause painful joints and heart problems. It can also follow a skin infection.

Patient.info explains that the bacterium involved is a Lancefield Group A beta-haemolytic streptococcus. Usually it causes a sore throat or skin infection that is treated with an antibiotic such as penicillin, and that is the end of the matter. In rheumatic fever the immune system overreacts and attacks the joints, heart and nervous system.

The NHS says it happens after a bacterial throat or skin infection, but most people who have such an infection will not get rheumatic fever. It is not caused by the bacteria itself but by your immune system fighting off the infection and attacking healthy tissue instead. It is not known why this happens, although the NHS says genes may make it more likely.

Rheumatic fever itself is therefore not contagious. The sore throat infection that comes before it is, which is why sore throats in someone who has had rheumatic fever should be treated early.

The NHS says treatment is to relieve the symptoms and control inflammation. You may need antibiotics, painkillers (tablets, capsules or liquid), steroids if pain is severe, and medicines to treat severe jerky, uncontrollable movements. Getting plenty of bed rest also helps recovery.

Patient.info adds that treatment depends on the body part affected. Aspirin or ibuprofen is usually enough for joint pains, which settle in a few weeks. Heart problems may need medicines that relieve strain on the heart, and sometimes heart valve damage is bad enough to need urgent surgery. Penicillin is usually given for ten days to clear any remaining bacteria.

The NHS says most people usually make a full recovery by about 3 months, but it can sometimes take longer. Patient.info similarly says the fever, joint pains, heart problems and chorea fade away by about three months in most people, with chorea very occasionally going on for years.

Patient.info says chorea develops in about a quarter of people, usually lasts a few weeks and fades, and tends to settle during sleep.

Patient.info says the main long-term problem is with the heart. Rheumatic fever can inflame the heart (carditis), including the covering of the heart, the muscle and the valves. It says about a third of people who have had rheumatic fever will get long-term heart problems, called rheumatic heart disease, which can need lifelong medication or valve surgery many years later.

The NHS says rheumatic heart disease can take years to show up, so you may need regular check-ups and further treatment when you are older.

Yes. The NHS says that if you have had rheumatic fever once it is more likely to come back, so sore throats should be treated early. You may have to take antibiotics for several years to help stop it returning. It is less likely to come back if it has been 5 years since your last episode, and the younger you are, the more likely it is to recur. Ask your doctor what ongoing treatment you need.

Patient.info says diagnosis is usually based on a history of a sore throat or skin infection followed, a few weeks later, by the typical features. A blood test (antistreptolysin titre) can show a recent streptococcal infection, and a scoring system uses major and minor criteria: two major criteria, or one major and two minor, are needed.

Major criteria are joint pains, heart problems, jerky movements and skin problems. Minor criteria are fever, raised inflammation markers on blood tests and changes on a heart trace (ECG). An echocardiogram is usually used to look for heart involvement.

The NHS says to see a GP if you have had rheumatic fever before and get a sore throat or think it has come back, or if you have had a bacterial throat infection recently and get symptoms of rheumatic fever. Chest pain with breathlessness or a fast heart rate needs urgent assessment: call NHS 111, or 999 or A&E if severe.

Rheumatic fever is very rare in the UK. Patient.info says it has practically disappeared from the UK since antibiotics became widespread, and still occurs in some other parts of the world. On the NHS, a suspected case would be assessed by a hospital paediatric or cardiology team, with GP follow-up for long-term antibiotics and heart checks. Private paediatric or cardiology review can offer a second opinion, but ongoing prevention plans should be shared with your GP.