Rheumatic Fever (Inflammatory Rheumatism) : Symptoms, Causes, Diagnosis & Treatment

Rheumatic fever (acute rheumatic fever) is a disease that can affect the heart, joints, brain, and skin. Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly. Early diagnosis of these infections and treatment with antibiotics are key to preventing rheumatic fever.

Although anyone can get rheumatic fever, it is more common in school-age children (5 through 15 years old). Rheumatic fever is very rare in children younger than three years old and adults.

In developing countries, the magnitude of ARF is enormous. Recent estimates suggest that 15.6 million people worldwide have rheumatic heart disease and that 470,000 new cases of rheumatic fever (approximately 60% of whom will develop rheumatic heart disease) occur annually, with 230,000 deaths resulting from its complications. Almost all of this toll occurs in the developing world.

It is difficult to self-diagnose rheumatic fever. Common symptoms include fever and painful, tender joints

How does Rheumatic Fever affect your body?

Rheumatic fever is not an infection itself, but rather the result of an untreated strep infection. When your body senses the strep infection, it sends antibodies to fight it. Sometimes, these antibodies attack the tissues of your joints or heart instead. If the antibodies attack your heart, they can cause your heart valves to swell, which can lead to scarring of the valve “doors” (called leaflets or cusps).

What are the Causes of Rheumatic Fever?

Rheumatic fever can occur after an infection of the throat with a bacterium called group A streptococcus. Group A streptococcus infections of the throat cause strep throat or, less commonly, scarlet fever. Group A streptococcus infections of the skin or other parts of the body rarely trigger rheumatic fever.

What are the Risk Factors of Rheumatic Fever?

Common risk factors include:

  • Family history – Some people carry a gene or genes that might make them more likely to develop rheumatic fever.
  • Type of strep bacteria – Certain strains of strep bacteria are more likely to contribute to rheumatic fever than are other strains.
  • Environmental factors – A greater risk of rheumatic fever is associated with overcrowding, poor sanitation and other conditions that can easily result in rapid transmission or multiple exposures to strep bacteria

What are the symptoms of Rheumatic Fever?

Symptoms of rheumatic fever include:

  • Fever
  • Painful, tender joints (arthritis), most commonly in the knees, ankles, elbows, and wrists
  • Fatigue
  • Jerky, uncontrollable body movements
  • Painless lumps (nodules) under the skin near joints
  • Rash that appears as pink rings with a clear center

How is Rheumatic Fever diagnosed?

Common diagnostic methods are –

  • Throat culture – Throat culture remains the criterion standard for confirmation of group A streptococcal infection. Rapid antigen detection tests are not as sensitive. If a rapid antigen detection test result is negative, obtain a throat culture in patients with suspected rheumatic fever. On the other hand, because of the high specificity of these tests, a positive rapid antigen test confirms a streptococcal infection.
  • Antibody titer tests – Antibody titer tests used include ASO test, antistreptococcal DNAse B (ADB) test, and the antistreptococcal hyaluronidase (AH) test. ASO is a test used to detect streptococcal antibodies directed against streptococcal lysin O. An elevated titer is proof of a previous streptococcal infection. It is usually more elevated after a pharyngeal than skin infection, while the ADB is typically elevated regardless of the site of the infection. Acute and convalescent sera, if available, are helpful for proving recent streptococcal infection.
  • Acute-phase reactants, erythrocyte sedimentation rate, and C-reactive protein – Acute-phase reactants, the erythrocyte sedimentation rate (ESR), and C-reactive protein levels (CRP) are usually elevated at the onset of ARF and serve as a minor manifestation in the Jones criteria. These tests are nonspecific, but they may be useful in monitoring disease activity.
  • Blood cultures – Blood cultures are obtained to help rule out infective endocarditis, bacteremia, and disseminated gonococcal infection
  • Chest radiography – Chest radiography can reveal cardiomegaly and CHF in patients with carditis.
  • Echocardiography – Echocardiography may demonstrate valvular regurgitant lesions in patients with ARF who do not have clinical manifestations of carditis. This does not qualify as carditis in the most recent Jones diagnostic criteria, as the clinical implications of subclinical carditis remain unclear, but some experts believe the diagnostic criteria for ARF should be modified to allow for specific abnormalities found only on echocardiograms to be included.

How to prevent & control Rheumatic Fever?

The only way to prevent rheumatic fever is to treat strep throat infections or scarlet fever promptly with a full course of appropriate antibiotics.

Treatment of Rheumatic Fever Allopathic Treatment

Antibiotics – Doctors usually prescribe penicillin or another antibiotic to eliminate remaining strep bacteria. After you complete the full antibiotic treatment, your doctor will begin another course of antibiotics to prevent recurrence of rheumatic fever. People who have had heart inflammation during rheumatic fever might be advised to take the preventive antibiotic treatment for 10 years or longer.

Anti-inflammatory treatment – Your doctor will prescribe a pain reliever, such as aspirin or naproxen (Naprosyn), to reduce inflammation, fever and pain. If symptoms are severe, your doctor might prescribe a corticosteroid.

Anticonvulsant medications – For severe involuntary movements caused by Sydenham chorea, your doctor might prescribe an anticonvulsant, such as valproic acid (Depakene) or carbamazepine (Carbatrol, Tegretol, others).

Treatment of Rheumatic Fever- Homoeopathic:

Common medications to treat rheumatic fever include :

  • Aconite
  • Anacardium
  • Arnica
  • Arsenicum
  • Belladona
  • Bryonia
  • Cactus
  • Drosera
  • Eupatorium Perf.
  • Ferrum Phos.
  • Gelsimium
  • Kalmia
  • Nux Vomica
  • Rhus Tox
  • Salicylic Acid

Rheumatic Fever – Lifestyle Tips

  • Observe complete bed rest as long as pulse rate & ESR are high.
  • Give rest to joint by splints, in position of comfort.
  • Gradually initiate activity.
  • Maintain a healthy diet.
  • Restrict physical activity.

What are Recommended Exercises for Person with Rheumatic Fever

Patients are typically advised to rest through the acute illness and to then gradually increase activity; some clinicians monitor the ESR and restart activity only as it normalizes.

Rheumatic Fever & Pregnancy – Things to know

Rheumatic fever in adults is now rare. Though there are few reports of sudden death in late pregnancy or labour due to active rheumatic fever, all those patients had post-mortem evidence of old valvular damage predating pregnancy.

Common Complications Related to Rheumatic Fever

If rheumatic fever is not treated promptly, long-term heart damage (called rheumatic heart disease) may occur. Severe rheumatic heart disease can require heart surgery and result in death.

Other FAQs about Rheumatic Fever

Can rheumatic fever cause brain damage?

Rheumatic fever is a complication of a streptococcal pharyngitis infection (strep throat) that can cause damage to the heart, joints, brain, and skin. The use of antibiotics and improved sanitation has dramatically reduced rheumatic fever in developed countries.

How long can rheumatic fever last?

Rheumatic fever can last from 6 weeks to more than 6 months. Your long-term health depends on how your heart has been affected by the disease. Rheumatic fever can weaken the heart muscle and affect your heart’s ability to pump.

Is rheumatic fever hereditary?

It is not clear why some people who are infected with group A Streptococcus bacteria go on to develop rheumatic fever, while others do not; however, it appears that some families may have a genetic susceptibility to develop the condition. Treatment usually includes antibiotics and/or anti-inflammatory medications.

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