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Rheumatic Fever - Rheumatic Fever symptom, treatment, causes

Rheumatic Fever is an acute disease that causes inflammation in connective tissues (which connect and support other tissues), particularly in the joints and heart. The inflammation is a complication of STREPTOCOCCAL INFECTIONS in the throat or other parts due to the formation of immune complexes (antigen-antibody combinations in the bloodstream) that lodge in connective tissues and damage them. Rheumatic fever occurs most often in school age children, and although it has become uncommon in most developed countries over the last 50 years, it is still an important cause of chronic RHEUMATIC HEART DISEASE in many parts of the world. The connective tissue inflammation may also affect the nervous system and skin.

Rheumatic fever is an inflammatory disease which may develop after a Group A streptococcal infection (such as strep throat or scarlet fever ) and can involve the heart , joints , skin , and brain. Symptoms of rheumatic (roo-MAT-ik) fever generally appear within a few weeks after a strep throat infection. In the United States, rheumatic fever rarely develops before age 3 or after age 40 and is much less common than in developing countries, probably because antibiotics are widely used to treat streptococcal infections at an early stage. However, the incidence of rheumatic fever sometimes rises and falls in a particular area for unknown reasons. Overcrowded living conditions seem to increase the risk of rheumatic fever, and heredity seems to play a part. In the United States, a child who has a streptococcal throat infection but is not treated has only a 0.4 to 3% chance of developing rheumatic fever. About half of the children who have had rheumatic fever will develop it again after another streptococcal throat infection if it is not treated. Rheumatic fever follows streptococcal infections of the throat but not those of the skin (impetigo) or other areas of the body. The reasons are not known.

Rheumatic fever is an inflammatory condition involving the connective tissues in the body. The main symptoms fever, muscle aches, swollen and painful joints, and in some cases, a red, lattice-like rash typically begin one to six weeks after a bout of strep, although in some cases the infection may have been too mild to have been recognized.The joints most likely to become swollen from rheumatic fever are the knees, ankles, elbows, and wrists.  The pain often migrates from one joint to another. However, the greatest danger from the disease is the damage it can do to the heart. In more than half of all cases, rheumatic fever scars the valves of the heart, forcing this vital organ to work harder to pump blood. Over a period of months or even years particularly if the disease strikes again this damage to the heart can lead to a serious condition known as rheumatic heart disease, which can eventually cause the heart to fail. Because of antibiotics, rheumatic fever is now rare in developed countries. In recent years, though, it has begun to make a comeback in the United States, particularly among children living in poor, inner-city neighborhoods.  The disease tends to strike most often in cool, damp weather during the winter and early spring.

Symptom of Rheumatic Fever

Fever and arthritis are the most common symptoms. Joints, most often ankles, knees, wrists and elbows, become painful and tender and may also be hot, red and swollen. One or more joints may be affected and, as one joint improves, another may develop symptoms. If the heart is involved, HEART MURMUR and symptoms of HEART FAILURE (such as shortness of breath, weakness, and swelling of tissues due to accumulation of excessive fluid OEDEMA) may develop during the feverish stage, but more often heart damage progresses slowly and leads to the long-term problems of chronic rheumatic heart disease. Some common Symptoms of Rheumatic Fever :

• Fever
• Abdominal pain
• Joint swelling; redness or warmth
• Stomach pain or feeling less hungry.
• A raised, red rash on your chest, back, or stomach.
• Weakness, shortness of breath, or feeling very tired.
• Chest pain .
• Fatigue.
• Jerky body movements .

Nervous system involvement results in chorea uncontrollable, purposeless jerky or writhing movements. When chorea was the most prominent or only symptom, rheumatic fever used to be called Sydenham's chorea or St Vitus' dance. Skin symptoms include painless nodules under the skin over affected joints, and sometimes a rash thatcan appear briefly after most other symptoms have subsided.

Diagnosis and treatment of Rheumatic Fever

There are no specific tests for rheumatic fever, but the diagnosis is likely when typical symptoms and signs follow strepto-coccal throat infection or SCARLET FEVER. Treatment is by antibiotics to eradicate streptococci. and anti-inflammatory drugs to reduce inflammation and relieve pain. Recovery is gradual. and afterwards patients are checked regularly so that appropriate precautions can be taken if chronic rheumatic heart disease develops.

• Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) may help with joint pain and swelling. Corticosteroids may be used if NSAIDs are not effective.
• If inflammation is severe, the doctor may prescribe bed rest or severe restriction of physical activity for a period of time.
• Penicillin or other antibiotics may be given to treat a strep infection. People who have had rheumatic fever are at high risk of getting it again. To prevent another bout of rheumatic fever, you may need to take antibiotics regularly for several years after the initial infection. These may be given by mouth or by monthly injections.