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Rheumatic Fever | Overview

Rheumatic fever is a systemic immune disease that affects the joints, skin, heart, blood, vessels, and brain.

  • Rheumatic fever may develop after your child is infected with strep throat or scarlet fever
  • Rheumatic fever is very rare in the U.S. and can be prevented by the prompt diagnosis and treatment (with antibiotics) of strep throat

How Boston Children's Hospital approaches rheumatic fever:

Your child's treatment may include a course of antibiotics, anti-inflammatory medications, and a period of bed rest (often between two and twelve weeks).

Rheumatic Fever | Symptoms & Causes

What is rheumatic fever?

Rheumatic fever is a delayed autoimmune reaction to the streptococcus bacteria, which usually occurs only if your child isn't diagnosed and treated promptly. Symptoms usually start one to five weeks after your child has been infected.

Is rheumatic fever contagious?

No. Streptococcus bacteria is contagious, but rheumatic fever isn't.

What are the symptoms of rheumatic fever?

Each child may experience symptoms differently, but common symptoms include:

  • joint inflammation, including swelling, tenderness, and redness over multiple joints. The joints affected are usually the larger joints in the knees or ankles; the inflammation "moves" from one joint to another over several days.
  • small nodules or hard, round bumps under the skin
  • a change in your child's handwriting, or unusual jerky movements
  • a pink rash with odd edges
  • fever
  • weight loss
  • fatigue
  • stomach pains

Are there long-term effects?

Some children may develop heart disease, depending on the severity of their initial disease. Physical activity and sports may be restricted in your child, based on your child's physician's findings. Also, your child may need to receive antibiotics before having dental work done. This helps decrease the chance of infection migrating to the heart during the dental procedure. Consult your child's physician for more information.

Rheumatic Fever | Testing & Diagnosis

Your physician will make the diagnosis based on your child's medical history. Your doctor will conduct a complete physical exam (possibly including blood tests and an EKG) to confirm the presence of:

  • Major criteria including:
    • Inflammation of the heart
    • Inflammation of more than one joitn
    • Unusual jerky movements, often involving the face and hands
    • Nodules or small, hard bumps under the skin
    • Rash
  • Minor criteria including:
    • Fever
    • Joint pain
    • Changes in the EKG pattern

There is no definitive test for rheumatic fever. A diagnosis is made when there is evidence of a streptococcal infection plus the presence of either two major criteria or one major criterion and two minor criteria.

Rheumatic Fever | Treatments

Treatments vary based on your child's age, health, and medical history, the extent of your child's disease, his tolerance for specific medications, procedures, and therapies, and, of course, your own opinions and preference will be considered. Treatment in most cases combines the following three approaches:

  • Antibiotic treatment: Your child may continue to receive monthly doses of antibiotics to help prevent further complications.
  • Anti-inflammatory medication: To help decrease the swelling that occurs in the heart muscle, as well as to relieve joint pain.
  • Bed rest: Often for between two and twelve weeks, depending on the severity of your child's disease and the involvement of the heart and joints.

After having rheumatic fever, your child will need medications on a monthly basis to help decrease the chance of developing rheumatic fever again. Usually by the time your child is 18 and your child's physician feels he/she isn't at risk for developing heart disease, the antibiotic therapy may be stopped. Close follow-up with your child's physician is needed.

Rheumatic Fever | Programs & Services