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Rheumatic fever

Acute rheumatic fever


Rheumatic fever is an inflammatory disease that may develop after an infection with group A Streptococcus bacteria (such as strep throat or scarlet fever). The disease can affect the heart, joints, skin, and brain.



Rheumatic fever is common in developing countries worldwide. It does not often occur in the United States and other developed countries. When rheumatic fever does occur in the U.S., it is usually in isolated outbreaks. The latest outbreak in the U.S. was in the 1980s.

Rheumatic fever mainly affects children ages 5 -15 who have had strep throat or scarlet fever. If it occurs, it develops about 14 - 28 days after these illnesses.




  • Abdominal pain
  • Fever
  • Heart problems, which may not have symptoms, or may lead to shortness of breath and chest pain
  • Joint pain, arthritis (mainly in the knees, elbows, ankles, and wrists)
  • Joint swelling, redness, or warmth
  • Nosebleeds
  • Ring-shaped or snake-like skin rash on the trunk and upper part of the arms or legs
  • Skin lumps (nodules)
  • Sydenham chorea (emotional instability, muscle weakness and quick, uncoordinated jerky movements that mainly affect the face, feet, and hands)


Exams and Tests


Your health care provider will examine you and will carefully check your heart sounds, skin, and joints.

Tests may include:

  • Blood test for repeated strep infection (such as an ASO test)
  • Complete blood count (CBC)
  • Electrocardiogram (EKG)
  • Sedimentation rate (ESR -- a test that measures inflammation in the body)

Several factors called major and minor criteria have been developed to help diagnose rheumatic fever in a standard way.

The major criteria for diagnosis include:

  • Arthritis in several large joints
  • Heart inflammation
  • Nodules under the skin
  • Rapid, jerky movements (chorea, Sydenham chorea)
  • Skin rash

The minor criteria include:

  • Fever
  • High ESR
  • Joint pain
  • Abnormal EKG

You'll likely be diagnosed with rheumatic fever if you meet two major criteria, or one major and two minor criteria, and have signs of a past strep infection.




If you are diagnosed with acute rheumatic fever you will be treated with antibiotics.

Anti-inflammatory medications such as aspirin or corticosteroids reduce inflammation to help manage acute rheumatic fever.

You may have to take low doses of antibiotics (such as penicillin, sulfadiazine, or erythromycin) over the long term to prevent strep throat from returning.


Outlook (Prognosis)


If rheumatic fever returns, your health care provider may recommend you take low-dose antibiotics for a long time, especially during the first 3 -5 years after you first get the disease. Heart complications may be severe, especially if the heart valves are involved.


Possible Complications


  • Damage to heart valves (such as mitral stenosis and aortic stenosis)
  • Heart failure
  • Infection of the inner lining of your heart (endocarditis)
  • Inflammation of the membrane around the heart (pericarditis)
  • Irregular heart rhythms (arrhythmias)
  • Sydenham chorea


When to Contact a Medical Professional


Call your health care provider if you develop symptoms of rheumatic fever. Because several other conditions have similar symptoms, you will need careful medical evaluation.

If you have symptoms of strep throat, tell your health care provider. You will need to be evaluated and treated if you do have strep throat, to decrease your risk of developing rheumatic fever.




The most important way to prevent rheumatic fever is by getting quick treatment for strep throat and scarlet fever.




Low DE. Nonpneumococcal streptococcal infections, rheumatic fever. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 298.

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                Review Date: 5/11/2014

                Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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