Understanding Rheumatic Fever - the Basics

What Is Rheumatic Fever?

A rare but potentially life-threatening disease, rheumatic fever is a complication of untreated strep throat, caused by bacteria called Group A Streptococcus. The main symptoms -- fever, muscle aches, swollen and painful joints, and in some cases, a red, lattice-like rash -- typically begin one to six weeks after a bout of strep, although in some cases the infection may have been too mild to have been recognized.

Rheumatic fever can also cause a temporary nervous system disorder once known as St. Vitus' dance.  Today it is called chorea, or Sydenham's chorea.  This is a nervous disorder occurring chiefly in childhood or during pregnancy, closely associated with rheumatic fever, which is characterized by rapid, jerky, involuntary movements of the body.  People with mild cases of chorea may find it difficult to concentrate or write.  More severe cases can cause the muscles of the arms, legs, or face to twitch uncontrollably.

The joints most likely to become swollen from rheumatic fever are the knees, ankles, elbows, and wrists.  The pain often migrates from one joint to another.  However, the greatest danger from the disease is the damage it can do to the heart. In more than half of all cases, rheumatic fever scars the valves of the heart, forcing this vital organ to work harder to pump blood.  Over a period of months or even years -- particularly if the disease strikes again -- this damage to the heart can lead to a serious condition known as rheumatic heart disease, which can eventually cause the heart to fail. 

Because of antibiotics, rheumatic fever is now rare in developed countries.  In recent years, though, it has begun to make a comeback in the United States, particularly among children living in poor, inner-city neighborhoods.  The disease tends to strike most often in cool, damp weather during the winter and early spring.  In the United States, it is most common in the northern states.

What Causes It?

Rheumatic fever results from an inflammatory reaction to certain Group A Streptococcus bacteria.  The body produces antibodies to fight the bacteria, but instead the antibodies attack a different target: the body's own tissues.  The antibodies begin with the joints and often move on to the heart and surrounding tissues.  Because only a small fraction (fewer than 0.3%) of people with strep ever contract rheumatic fever, medical experts believe that other factors, such as a weakened immune system, must also be involved in the development of the disease.

CAUTION! Monitor That Sore Throat

Pay attention to sore throats, especially in children. If your child has a severe sore throat without other cold symptoms, accompanied by a fever higher than 101 degrees F, or a milder sore throat that persists for more than two or three days, see a doctor.  It may be strep throat, which should be treated with antibiotics.