Rheumatic Fever

Rheumatic (roo-MAH-tik) fever is a complication of a group A streptococcal infection, such as strep throat or scarlet fever, that can lead to permanent heart damage and death. It is most common in children.

Rheumatic Fever: Its Ups and Downs


In the mid-19th century, the Reverend Edmund Stone (1702–1768) unwittingly discovered the earliest known effective treatment for rheumatic fever and other conditions characterized by rheumatism. Stone, like many physicians of his time, believed that God grew healing herbs for specific diseases in the localities where those diseases naturally occurred. Willing to put his idea to the test, he administered willow bark, which he himself sampled, to some 50 people suffering with rheumatic fever. He reported effective results in each case. The bark was later found to contain the active ingredient salicin (SAL-i-sin), first extracted and analyzed by Dr. Thomas MacLagan (1838–1903) in 1874. Other chemists later produced the salicylate (sal-i-SY-late) group of drugs, which yielded sodium salicylate in 1899. This drug came to be known as aspirin and became useful for remedying symptoms associated with rheumatic fever as well as pain from other causes.

By the early 1980s, only about 1 in every 100,000 Americans developed rheumatic fever. But by 1985, the disorder had reemerged as a significant problem in some communities. There were outbreaks in Salt Lake City, New York, Dallas, San Diego, Akron, and Columbus.

Doctors were puzzled and renewed their interest in fighting rheumatic fever. The number of cases remained small in the United States, while in poor, less-developed countries rheumatic fever was a significant problem. Doctors were uncertain if the fever's comeback in the United States was temporary, but it showed that everyone needs to be watchful for the effects of strep infections.

From a Sore Throat to a Damaged Heart

Rheumatic fever sometimes results when the body's immune system reacts to infection by a bacterium known as group A streptococcus, commonly called strep. The same bacteria that cause strep throat can lead to other disorders, such as scarlet fever.

When the body becomes infected with the strep bacteria, the immune system * produces antibodies to fight the infection. Rheumatic fever results when these antibodies begin to attack other parts of the body instead of just fighting the infection. The antibodies react to organs such as the heart as if they were the strep bacteria, perhaps because parts of these organs are chemically similar to strep.

Doctors are not sure exactly why some strep infections develop into rheumatic fever and others do not. The disorder occurs most often in children between 5 and 15 years of age, although it can strike younger children and adults, too.

Rheumatic fever is an inflammatory disease that can develop as a complication of untreated strep throat or scarlet fever.

Rheumatic fever is an inflammatory disease that can develop as a complication of untreated strep throat or scarlet fever. A red rash that starts at the head and neck and then expands to the trunk and extremities is one of the symptoms of rheumatic fever.
Biophoto Associates/Science Source.

A Turn for the Worse

The first signs of rheumatic fever usually occur within several weeks after a strep throat infection. Sometimes people appear to have recovered from the sore throat but suddenly begin to show other symptoms, such as:

The most dangerous consequence of rheumatic fever is inflammation and weakening of the heart muscle. The valves that control passage of blood in and out of the heart can be damaged so that they fail to open and close properly. This condition is called rheumatic heart disease. During an acute episode of rheumatic fever, a physical examination might produce abnormal findings regarding the heart; however, these can be subtle. The heart damage that leads to poor function of the cardiac valves may take months to years to develop (after the initial episode) with symptoms and clinical findings on cardiac examination.


Sydenham's chorea is the name for the involuntary movements and twitching that some rheumatic fever patients display.

During the Middle Ages, chorea (pronounced like the country Korea) was the term used to describe people who traveled to the shrine of St. Vitus in what later became Germany. Some of the people apparently suffered from conditions involving abnormal body movements, such as epilepsy, and hoped to be healed at the shrine. (Catholics consider St. Vitus the patron saint of those with epilepsy, as well as of dancers and actors.)

Thomas Sydenham (1624–1689), a prominent physician in England during the 1600s, used the term chorea in connection with infectious diseases such as scarlet fever. Later, when rheumatic fever was also connected with strep infection, Sydenham's chorea was the term used to describe the shaking of the upper limbs and face caused by swelling of the brain.

Chorea comes from the Greek word for dance. Thus, Sydenham's chorea is sometimes called St. Vitus's dance.

The Importance of Antibiotics

A doctor may suspect a strep infection if a patient with a sore throat also has a fever and severe headache. However, the symptoms and physical exam findings in people with strep throat are very similar to those in people with sore throat due to a virus infection or other cause. Therefore, strep infections must be confirmed with laboratory tests. Doctors use a cotton swab to wipe the throat to test for the strep bacteria.

If the infection is caused by strep, the doctor usually prescribes an antibiotic to be taken by mouth for several days or given as a one-time shot. Doctors stress that it is important to take all the antibiotic prescribed, even if the symptoms of the strep infection disappear.

Not all untreated strep infections lead to complications such as rheumatic fever. For people who get rheumatic fever, doctors use antibiotics as well as other drugs that reduce swelling and relieve pain. They also closely watch the heart to ensure that there are no problems with blood flowing through it. If the heart valves are damaged, surgery might be necessary to fix one or more valves.

The best way to avoid rheumatic fever is to treat strep infection promptly with antibiotics. Doctors, however, are concerned that some bacteria may become resistant to traditional antibiotics. Researchers continue to explore the best ways to use antibiotics and the development of new drugs to fight infections.

See also Heart Disease: Overview • Scarlet Fever • Sore Throat/Strep Throat • Streptococcal Infections


Books and Articles

Krishna Kumar, R., and R. Tandon. Rheumatic Fever & Rheumatic Heart Disease: The Last 50 Years. Indian Journal of Medical Research 137, 4 (April 2013): 643–58. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724245/ (accessed November 16, 2015).

Taranta, Angelo, and M. Markowitz. Rheumatic Fever: A Guide to Its Recognition, Prevention, and Cure with Special Reference to Developing Countries. New York: Springer, 2011.


National Organization for Rare Disorders. “Rheumatic Fever.” https://rarediseases.org/rare-diseases/rheumatic-fever/ (accessed November 16, 2015).

NHS Choices. “Rheumatic Fever.” National Health Services. (accessed August 12, 2015).


American Heart Association. 7272 Greenville Ave., Dallas, TX 75231. Toll-free: 800-242-8721. Website: http://www.heart.org (accessed August 12, 2015).

National Organization for Rare Disorders. 55 Kenosia Ave., Danbury, CT 06810. Telephone: 203-744-0100. Website: http://rarediseases.org (accessed November 16, 2015).

World Health Organization. Avenue Appia 20, 1211 Geneva 27, Switzerland. Telephone: 41-22-791-21-11. Website: http://www.who.int (accessed August 24, 2015).

World Heart Federation. 32, rue de Malatrex, 1201 Geneva, Switzerland. Telephone: 41-22-807-03-20. Website: http://www.worldheart-federation.org (accessed November 16, 2015).

* immune system (im-YOON SIStem) is the system of the body composed of specialized cells and the substances they produce that help protect the body against disease-causing germs.

Disclaimer:   This information is not a tool for self-diagnosis or a substitute for professional care.

(MLA 8th Edition)