Rheumatic Fever
Does rheumatic fever have long-term consequences? All the information about this disease: causes, symptoms, and treatment.
Symptoms and Causes
Rheumatic fever is a systemic inflammatory disease caused by an autoimmune response to an infection from Group A hemolytic streptococcus bacteria, such as strep throat or scarlet fever. It causes damage to the heart, joints, central nervous system, and skin. Recurrence is common, and it is typical for patients to experience recurrent episodes.
It typically affects children aged 5 to 15, and although it is very rare in developed countries, it remains a serious health issue in developing areas.
Symptoms
The symptoms of rheumatic fever usually appear two to four weeks after contracting the streptococcal infection and can vary over the course of the disease:
- Fever.
- Fatigue.
- Pain and inflammation in the joints, especially in the knees, ankles, elbows, and wrists. It can spread from one joint to another.
- Heat sensation and swelling in the joints.
- Chest pain.
- Heart murmur.
- Small, painless subcutaneous nodules.
- Flat or slightly raised skin rash with irregular borders, painless.
- In some cases, Sydenham’s chorea, a movement disorder characterized by uncontrollable spasms in the hands, feet, and face, accompanied by abnormal bursts of laughter or crying.
Causes
As mentioned earlier, rheumatic fever results from an untreated streptococcal throat infection caused by Group A hemolytic streptococcus. The exact mechanism that leads to rheumatic fever from the infection is not fully understood, but it seems to be due to certain antigens produced by the infection that resemble heart tissue, triggering a generalized immune response that causes systemic inflammation. Additionally, several studies suggest a genetic predisposition both to contracting streptococcal infections and to responding inappropriately to them.
Risk Factors
The risk of developing rheumatic fever increases with the following factors:
- Genetic alteration that predisposes individuals to streptococcal infections.
- Specific type of streptococcus: certain strains are more likely to cause rheumatic fever.
- Environmental factors: overcrowding and lack of sanitation facilitate the spread of streptococcus.
- Insufficient antibiotics: the recurrence of rheumatic fever is more common in individuals who do not take antibiotics regularly.
Complications
The inflammation in tissues and joints caused by rheumatic fever can lead to severe long-term consequences, which may be permanent, especially in the heart. The most notable complications include:
- Rheumatic heart disease or rheumatic cardiac disease: damage to the heart valves, causing them to stiffen, narrow, or fuse, reducing blood flow in the heart.
- Myocardial weakness, leading to reduced pumping capacity.
- Endocarditis.
- Heart failure.
Prevention
The most effective way to prevent rheumatic fever is to treat streptococcal throat infections immediately with antibiotics and to complete the entire prescribed antibiotic course.
Which doctor treats rheumatic fever?
Rheumatic fever is treated by specialists in the cardiovascular risk unit, cardiology, internal medicine, and cardiovascular surgery.
Diagnosis
There is no single test to confirm rheumatic fever. Diagnosis is based on the combination of symptoms and evidence of previous streptococcal infection. Several tests can support the diagnosis and locate potential damage:
- Blood tests to look for inflammation markers, such as elevated C-reactive protein (CRP) or high sedimentation rate. Streptococcal antibodies are also sought to confirm prior infection.
- Electrocardiogram: records the heart's electrical activity to identify abnormalities suggesting infection.
- Echocardiogram: ultrasound images of the moving heart are captured to examine the function of the myocardium and valves.
The diagnostic criteria, known as the Jones Criteria, divide the signs of rheumatic fever into major and minor criteria. The presence of two major criteria and one minor or two minor criteria and one major, along with evidence of streptococcal infection, makes the diagnosis of rheumatic fever very likely.
- Major criteria: arthritis, heart inflammation, subcutaneous nodules, skin rash, and Sydenham’s chorea.
- Minor criteria: fever, elevated sedimentation rate, arthralgia, prolonged PR interval on the electrocardiogram, previous rheumatic fever, and elevated CRP.
Treatment
The treatment of rheumatic fever aims to eliminate the infection, prevent recurrence, and control inflammation and symptoms:
- Antibiotics, usually penicillin, to combat streptococcal bacteria. Antibiotics may need to be taken in cycles lasting several years or for life, especially if there has been heart inflammation, due to the risk of recurrence.
- Anti-inflammatory drugs, such as aspirin or naproxen, to reduce inflammation, fever, and pain.
- Corticosteroids if symptoms do not improve with anti-inflammatory drugs.
- Anticonvulsants to treat Sydenham’s chorea spasms.
- Regular cardiac monitoring: heart damage caused by rheumatic fever may not manifest until years or decades later.
