Rheumatic fever in children
Rheumatic fever is a disease that happens when your child’s body has a reaction to a strep throat infection that wasn’t treated or fully treated.
Hearing your child is diagnosed with rheumatic fever can feel overwhelming. Our team of pediatric rheumatology specialists is here to help ease your concerns. Your child’s care team will provide personalized care to manage rheumatic fever symptoms, prevent complications and support your child’s recovery.
What is rheumatic fever?
Acute rheumatic fever is the first stage of rheumatic fever, when the symptoms start showing up for the first time. This is when symptoms such as a fever, joint pain, rashes or heart problems suddenly happen.
Rheumatic fever is a rare condition where your child’s immune system reacts incorrectly to an untreated or improperly treated strep throat or scarlet fever infection. Rheumatic fever is an autoimmune response to the infection.
Instead of targeting the strep bacteria, the immune system mistakenly attacks healthy tissues, causing widespread inflammation in your child. This inflammation can affect various parts of the heart, including the inner lining, heart muscle and the thin sac around the heart, leading to conditions such as pericarditis.
During the initial stages, known as acute rheumatic fever, symptoms such as fever, joint pain, rheumatic fever rash or heart problems can suddenly happen. These symptoms can lead to long-term problems if not treated, including damage to your child’s heart.
How often does strep throat lead to rheumatic fever?
Strep throat is a common infection in children, but it rarely leads to rheumatic fever if the infection is treated promptly with antibiotics. However, when strep throat or scarlet fever is left untreated or not completely treated, the risk of developing rheumatic fever increases.
Studies suggest that less than 1% of untreated strep throat cases may progress to rheumatic fever, but the risk is higher in places such as rural areas with limited access to health care or in groups where recurrent strep infections are common.
Rheumatic fever symptoms
Rheumatic fever symptoms vary, often making the condition difficult to diagnose or notice. Symptoms typically appear two to four weeks after a strep throat infection and may range from mild to severe.
Common symptoms of rheumatic fever include:
- Joint pain and swelling: Pain and swelling of joints (knees, ankles, elbows, and wrists) that may shift from one joint to another.
- Rheumatic fever rash: A pink rash with clear centers, often called erythema marginatum, that doesn’t itch or cause pain, making it easy to overlook.
- Heart problems: Chest pain, shortness of breath, and fatigue caused by inflammation around the heart (carditis), which may progress to rheumatic heart disease if untreated.
- Chorea: Uncontrolled, jerky movements, especially in the face and hands, which are common in children and a key sign of acute rheumatic fever.
- Nodules: Small, painless lumps that form under the skin, typically near joints.
Schedule an appointment with your pediatrician if your child shows any of these symptoms.
What is the main cause of rheumatic fever?
Rheumatic fever is primarily caused by an untreated or improperly treated strep throat or scarlet fever infection due to Group A beta-hemolytic streptococcal pharyngitis (GABHS). While the initial strep infection affects the throat, the immune system’s abnormal response to the bacteria can lead to inflammation in the heart, joints, skin and brain, leading to rheumatic fever.
Complications of rheumatic fever
Rheumatic fever can have serious complications and lead to heart disease. The inflammation may cause lasting damage to the heart valves, potentially leading to heart failure, arrhythmias or the need for valve replacement surgery later in life. Other complications include chronic arthritis, heart failure or recurring rheumatic fever episodes.
How quickly does rheumatic fever progress?
Acute rheumatic fever typically begins between two and four weeks after a strep throat infection. The condition progresses based on your child’s health, the severity of the initial infection and whether treatment is started promptly.
Diagnosing rheumatic fever
Your child’s pediatrician will do a thorough medical evaluation, including a physical exam, symptom review and diagnostic tests.
Your child’s doctor may check for:
- Fever
- Joint pain and swelling
- Rash
- Heart murmurs
Tests used to confirm rheumatic fever include:
- Throat culture or rapid strep test to identify streptococcus bacteria.
- Blood tests to check for elevated inflammatory markers and strep antibodies.
- Echocardiogram to evaluate potential damage to the heart or valves.
If rheumatic fever is diagnosed, your child’s pediatrician may work with a pediatric rheumatologist to plan individualized treatment for your child.
Rheumatic fever treatments
Treating rheumatic fever focuses on eliminating the strep infection, reducing inflammation and managing symptoms.
Common treatments include a course of penicillin or other antibiotics to kill the streptococcus bacteria. Antibiotic prophylaxis may be recommended to prevent recurrence. Drugs like aspirin or corticosteroids can help reduce joint pain and inflammation.
Your child’s pediatrician may order strict rest in severe cases to minimize strain on the heart. If your child has heart complications, medications may be prescribed to manage symptoms such as shortness of breath or fluid retention. In cases of rheumatic heart disease, ongoing care may include surgical interventions such as valve repair or replacement.
Preventing rheumatic fever
The best way to prevent rheumatic fever is by treating strep throat promptly. If your child has symptoms of strep throat, such as a sore throat, fever or difficulty swallowing, consult your doctor.
Scarlet fever, another condition caused by strep bacteria, should also be treated immediately to reduce the risk of rheumatic fever.
Encourage your child to practice good hygiene, such as frequent handwashing, to prevent the spread of strep throat.
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