RHEUMATIC FEVER

 Basic information

description

Rheumatic fever is an inflammatory disorder that affects many parts of the body, especially the joints and heart. It occurs following group A streptococcal pharyngitis (strep throat). Strep infections are contagious, but rheumatic fever is not. It can affect all ages, but it is most common in ages 5 to 15.

FREQUENT SIGNS & SYMPTOMS

• Joint inflammation that causes pain, redness, swelling, and warmth. Wrists, elbows, knees, or ankles are most often affected. The symptoms may move from one joint to another.
• Fever; fatigue; paleness.
• Appetite loss; general ill feeling.
• Stomach (abdominal) pain; chest pain.
• Mild skin rash on the chest, back, and abdomen.
• Small, painless bumps just under the skin in bony areas such as the elbows or knees.
• Uncontrolled arm and leg movement (chorea).
• If the heart is involved:
  • Shortness of breath.
  • Fluid build-up that causes swelling of legs and back.
  • Rapid heartbeat, especially when lying down.

causes

Rheumatic fever is caused by a preceding strep infection in the throat that occurs 1 to 6 weeks prior to the start of symptoms. It is probably an autoimmune disorder in which antibodies produced by the body to attack the strep bacteria also attack tissues of the joints or heart.

risk increases with

• Family history of rheumatic fever.
• Crowded or unclean living conditions.
• Poor nutrition.

PREVENTIVE MEASURES

Obtain prompt antibiotic treatment of any strep infection, including those of the skin. Strep infections must be treated with antibiotics.

expected outcomes

Strep infections are usually curable with treatment. Rheumatic fever is treatable, but not curable. It usually resolves in 2 to 12 weeks. Some cases may take 15 weeks or more.

possible complications

• Rheumatic heart disease. In some cases, rheumatic fever may permanently damage the heart valves. It may take 10 to 30 years for symptoms of valve damage to appear. A damaged valve can usually be replaced with surgery.
• Relapse of rheumatic fever.

 diagnosis & treatment

general measures

• Your health care provider will do a physical exam and ask questions about your symptoms and previous illnesses. Medical tests may include blood studies, a throat culture, and x-rays of the chest and heart. An ECG (electrocardiogram) may be done. This test measures electrical activity of the heart. No test is specific to diagnose rheumatic fever.
• Treatment includes rest and drugs to treat the symptoms and to prevent rheumatic fever from recurring. Home care is recommended for some cases. Hospital care may be required for more severe cases.
• To learn more: American Heart Association, 7272 Greenville Ave., Dallas, TX 75231; (800) 242-8721; web-site: www.americanheart.org.

medications

• Your health care provider may prescribe:
  • Drugs to reduce inflammation.
  • Diuretics to reduce fluid build-up in the body.
  • Drugs for congestive heart failure if it occurs.
  • Antibiotics for strep bacteria. Once rheumatic fever reaches the inactive stage, low-dose antibiotics may be continued indefinitely to prevent recurrence. They may be taken by mouth or given as an injection.

activity

Bed rest normally (or very limited activity) until studies show the disease has subsided. Then return to normal activities gradually. Your health care provider will advise when to return to school.

diet

• A liquid or soft diet in the early stages. Then provide a normal diet high in protein, calories, and vitamins.
• A low-salt diet may be recommended if patient has carditis (inflammation of the heart).

 notify our office if

• You or your child has symptoms of rheumatic fever.
• Symptoms occur during treatment (e.g., swelling of the legs or back, shortness of breath, cough, vomiting, fever, diarrhea, or severe abdominal pain).

Special Notes: