All about rheumatic fever; From symptoms to treatment

What is rheumatic fever?
Rheumatic fever is a serious disease that can be life-threatening if left untreated. This disease occurs when a purulent sore throat, caused by group A streptococcus bacteria, is not treated properly. Symptoms usually start a few weeks after getting a sore throat and can include fever, muscle aches, joint swelling and pain, and sometimes a red rash. However, sometimes the infection may be so mild that you don’t notice it.


Knee, ankle, elbow and wrist joints are usually affected. Pain can be transferred from one joint to another. But the biggest danger of this disease is the damage it causes to the heart. More than half of the time, rheumatic fever damages the heart valves, making the heart work harder to pump blood. Over time, this damage can lead to a serious condition called rheumatic heart disease, which can eventually lead to heart failure.


Rheumatic fever can also cause a temporary nervous system disorder called Sydenham’s, formerly known as St. Vitus’ dance. This disorder causes rapid and sudden movements of the body, usually on one side. It can make it difficult for people with mild cases to concentrate or write, while more severe cases can cause uncontrollable shaking of the arms, legs or face, along with muscle weakness and outbursts of anger.


Thanks to antibiotics, rheumatic fever is now rare in developed countries. However, cases of the disease have recently increased in the United States, particularly among children in poor urban areas. The disease tends to occur more in the cold, wet weather of winter and early spring, and is more common in the northern states of the United States.

Scarlet fever against rheumatic fever:
Scarlet fever is a highly contagious and usually mild bacterial disease that causes fever, sore throat, and skin rash. This disease is related to rheumatic fever in several ways. Both of these diseases are caused by group A streptococcus bacteria. One of the causes of rheumatic fever is not treating scarlet fever. While scarlet fever is contagious, rheumatic fever is not.


The cause of rheumatic fever
Rheumatic fever occurs when your body reacts to a specific group A streptococcus bacteria. Instead of just fighting the bacteria, your body’s antibodies mistakenly attack your own tissues. This attack starts from the joints and then it can affect the heart and surrounding tissues. Only a very small number of people with purulent sore throat, less than 0.3%, develop rheumatic fever. Experts believe that other factors are also involved, such as having a weak immune system. Also, if you do not treat the scarlet fever infection, you may develop rheumatic fever.


Symptoms of rheumatic fever
Rheumatic fever symptoms usually appear 1 to 5 weeks after an untreated purulent sore throat or scarlet fever infection. But in some cases, a person with rheumatic fever may not remember having a sore throat. The most important symptoms of rheumatic fever are:

• Swollen, sensitive, red and extremely painful joints, especially knees, ankles, elbows or wrists


• A red, raised, mesh-like rash, usually on the chest, back, and abdomen

• Small lumps or bumps on swollen joints

Chest pain, palpitations or shortness of breath (caused by heart attack)

• Sudden and uncontrollable movements of arms, legs or facial muscles (called rheumatic chorea)


Monitor throat hygiene:

Pay attention to sore throats, especially in children. See your doctor if your child develops a sore throat without other cold symptoms, along with a fever higher than 38 degrees Celsius (100.4 degrees Fahrenheit) or a milder sore throat that lasts more than 2 or 3 days. This may be a purulent sore throat that should be treated with antibiotics.


When to call your doctor:
Call your doctor if you have symptoms of rheumatic fever, especially a recent sore throat.

• Symptoms of rheumatic fever, especially recent sore throat.

• Sore throat without other cold symptoms with fever above 38.3°C (101°F) and swollen glands in the neck.

• Sudden and unexplained joint pain after recovery from purulent sore throat.

Risk factors for rheumatic fever
Rheumatic fever can affect anyone who has had a purulent sore throat, scarlet fever, or impetigo. But some people are more susceptible to this disease, including:

• Children 5 to 15 years old

• People who are in crowded groups such as schools, kindergartens and military training centers.

• People who have suffered from rheumatic fever in the past and again have purulent sore throat, scarlet fever or boils.

Diagnosis of rheumatic fever
To find out if you have strep bacteria, your doctor will do a ring culture. This procedure, which is a bit uncomfortable but safe, involves taking a sample of throat mucus with a swab. The doctor sends the sample to a laboratory for analysis, which usually takes 24 hours. Some doctors use a rapid strep test, which can give results in 5 minutes, but is not as accurate as a culture.


Your doctor will also do a thorough exam, which will include listening to your heart for any problems, such as “heart murmurs” (indicative of possible valve problems). They also look for other telltale signs, such as arthritis (joint inflammation) in more than one joint and small bumps that often appear on the joints, especially the elbows.


Other tests to diagnose rheumatic fever include:

• Blood test to check for antibodies related to recent group A strep infection

An electrocardiogram (EKG) or EKG to check heart function

• Echocardiography or echo that shows the function of the heart muscle live.

Treatment of rheumatic fever
Your doctor will prescribe standard treatments that can reduce your risk of heart disease and other health problems associated with rheumatic fever. You will likely take these treatments for a long time. Alternative therapies can also be useful by helping conventional treatments to reduce symptoms and prevent disease recurrence.


You will need plenty of rest, and your doctor may prescribe penicillin or other antibiotics to kill the bacteria causing the fever. You may need to take long-term antibiotics to prevent the disease from recurring. Also, if you have fever, swelling, arthritic joint pain, or other symptoms, your doctor may prescribe aspirin or other anti-inflammatory medications such as ibuprofen or naproxen. They may also prescribe corticosteroids.


If you have rheumatic heart disease, you may need to take antibiotics at certain times, such as before dental work or surgery, to prevent heart valve swelling again. In severe cases, surgery can repair damage to the heart valves and prevent heart failure.


Complications of rheumatic fever
Weeks or even months after rheumatic fever, you may still experience joint and tissue swelling. This swelling can cause long-term health problems in some people. Another health problem, rheumatic heart disease, usually appears years after your initial illness, but heart valve damage can occur even when you still have symptoms.


Other types of heart damage caused by rheumatic fever include:

• Stenosis or narrowing of the heart valve that restricts blood flow through the valve.

• Valve regurgitation, which occurs when blood flows backward into the heart because the valve’s rim does not close properly.

• Damage to the heart muscle from swelling caused by rheumatic fever that affects how the heart pumps blood.

• An irregular heartbeat, called atrial fibrillation (AFib), which is caused by damage to the heart valves and other parts of the heart.

Frequently asked questions about rheumatic fever
1. How many people with purulent sore throat develop rheumatic fever?

About 0.3 to 3 percent of people who get a strep throat infection develop rheumatic fever, even without treatment.


2. Is rheumatic fever contagious?

no Because it is an immune response and not an infection, you cannot catch it from another person. But if you have group A strep infection or scarlet fever, you can pass it on to others.


3. What should I do if I think I have rheumatic fever?

If you think you may have rheumatic fever, it’s important to see your doctor as soon as possible. Early diagnosis and treatment can help prevent serious complications.


4. Can I live a normal life with rheumatic fever?

With proper treatment, most people with rheumatic fever can lead a normal and healthy life. However, it is important to see your doctor regularly to monitor your symptoms and prevent possible complications.


The last message
Rheumatic fever is a rare but serious bacterial disease that can result from untreated purulent sore throat or scarlet fever. Symptoms of this disease usually appear 2 to 4 weeks after streptococcal infection. Although rare in developed countries, the disease has re-emerged in the United States. Other health problems from the disease, such as heart damage, can appear years after your first illness. Treatments include antibiotics and medication to reduce swelling, while people with severe cases may need surgery to repair heart damage.

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