Acute Rheumatic Fever

Acute rheumatic fever is an inflammatory condition that can develop after an untreated or inadequately treated streptococcal throat infection. It can affect the heart, joints, skin, and nervous system, and repeated episodes can cause long-term heart valve damage (rheumatic heart disease).

• Fever, often 2–4 weeks after a sore throat
• Migratory joint pain and swelling, typically moving from one large joint to another (such as knees, ankles, elbows, or wrists)
• Inflammation of the heart (carditis), which may cause a new heart murmur, breathlessness, or chest discomfort
• Involuntary, jerky movements (Sydenham's chorea) in some cases, particularly in children
• A distinctive skin rash or small, painless nodules under the skin occur less commonly

• Follows an abnormal immune response to a prior group A Streptococcus throat infection that was untreated or inadequately treated.
• Risk is increased by lack of access to prompt care for sore throat, overcrowding, and repeated streptococcal throat infections, particularly in school-age children.

• Diagnosed using a set of major and minor clinical criteria (such as carditis, joint involvement, chorea, and characteristic skin findings) together with laboratory evidence of a recent streptococcal infection.
• Echocardiography, where available, helps detect heart valve inflammation or damage even before it is clinically obvious.
• Blood tests for markers of inflammation and evidence of recent streptococcal infection support the diagnosis.

Aspirin or another anti-inflammatory medicine is used to control fever and joint inflammation during the acute episode.

A course of antibiotics (typically penicillin) is given to eliminate any remaining streptococcal infection, even if throat swabs are now negative.

Significant heart inflammation (carditis) is managed at hospital level, with careful monitoring and additional treatment as needed depending on severity.

After the acute episode, long-term monthly injections of benzathine penicillin are recommended for a number of years (or longer, depending on whether heart involvement occurred) to prevent recurrent episodes and further heart damage — this secondary prevention is one of the most important parts of long-term care.

Patients who develop significant valve damage (rheumatic heart disease) are followed by a specialist and may eventually need valve surgery.

• Seek prompt treatment for sore throat in children, and complete the full course of antibiotics when streptococcal infection is diagnosed or likely.
• Ensure strict adherence to long-term penicillin prophylaxis for anyone who has had rheumatic fever, as missed doses increase the risk of another episode and further heart damage.
• Reduce overcrowding where possible, as it increases the spread of streptococcal throat infections.
• Attend regular cardiac follow-up if there has been any heart involvement.