Rheumatic Fever: What It Is, Causes, Symptoms, Treatment & Types

What is Rheumatic Fever?

Rheumatic fever is an autoimmune inflammatory disease that can develop after an infection from the Group A Streptococcus bacteria, usually strep throat. Instead of attacking the bacteria alone, the immune system attacks healthy tissues, especially the heart, joints, skin, and central nervous system, leading to inflammation and complications.

Rheumatic fever is not contagious. But the bacterial throat infection that causes it can be passed from person to person via respiratory droplets.

What are the Types of Rheumatic Fever?

Rheumatic fever is a disease with clinical types, rather than multiple types. Doctors, however, classify it according to the organs that are chiefly involved:

How Common is Rheumatic Fever in India?

Rheumatic fever is a public health problem in India despite the decrease in incidence over the past few decades. According to the National Medical Journal of India's article, 40% of rheumatic heart disease patients in the world are in India.

Hospital-based studies and regional surveillance programmes indicate that rheumatic fever and rheumatic heart disease are present among school-age children and adolescents. This is mainly due to overcrowding and late treatment of streptococcal infections. Public health experts continue to emphasise the early diagnosis and antibiotic treatment of streptococcal throat infections to reduce the burden of the disease.

What are the Symptoms of Rheumatic Fever?

Symptoms of rheumatic fever usually appear two to four weeks after infection with group A Streptococcus in the throat. Initial symptoms mostly involve inflammatory responses, while later symptoms are a result of heart or nervous system involvement. The early signs and advanced symptoms of rheumatic fever are listed below:

What are the Stages of Rheumatic Fever?

Rheumatic fever has a number of well-recognised clinical phases, beginning with a streptococcal throat infection and leading in some cases to chronic heart valve disease if untreated.

Although the disease does not have any clinically defined stages, it can be classified into phases of disease progression, as highlighted in the table below:

Diseases Similar to Rheumatic Fever

Rheumatic fever is often confused with the 'rheumatic' diseases, including rheumatic heart disease and rheumatoid arthritis, which have similar names or symptoms, such as joint pain. But these are different conditions with different causes, affected organs and treatment strategies.

Rheumatic Fever Vs. Rheumatic Heart Disease Vs. Rheumatoid Arthritis

What Causes Rheumatic Fever?

Rheumatic fever develops because of an abnormal immune response following an infection with Group A Streptococcus bacteria.

Common causes and risk factors of rheumatic fever include:

• Untreated Streptococcal Throat Infection: Not treating strep throat infection on time increases the risk of the disease.

• Delay in Antibiotic Therapy: Inadequate therapy permits an immune response to develop.

• Autoimmune Response: The immune system attacks healthy tissues by mistake because bacterial proteins and human tissues have similar molecular structures.

• Frequent Streptococcal Infections: If you have a lot of sore throats, you may be more likely to get an autoimmune response.

• Genetic Factors: A family history of the condition may influence an individual's immune system.

• Overcrowded Housing: Close quarters can spread bacteria easily among people.

• Poor Access to Healthcare: Delay in diagnosis and treatment leads to more complications.

• School-Age Children: Rheumatic fever is most commonly seen in children between 5 and 15 years of age.

What are the Complications of Rheumatic Fever?

Without timely treatment, rheumatic fever may lead to both short-term and long-term complications.

Potential complications include the following:

• Rheumatic Heart Disease: Repeated inflammation can lead to permanent damage to heart valves.

• Heart Valve Damage: Damage to the mitral valve is especially common.

• Heart Failure: Extensive valve damage can affect the heart's functionality.

• Cardiac Arrhythmias: Abnormal heart rhythms can develop because of structural changes.

• Recurrent Rheumatic Fever: Future streptococcal infections can trigger further attacks.

• Joint Problems: Some patients have long-term symptoms of arthritis.

• Neurological Problems: Sydenham chorea can affect daily activities.

• Reduced Quality of Life: Chronic heart disease can affect physical function in the long term.

When Should I See My Healthcare Provider?

If you or your child has any of the following symptoms after a recent sore throat or streptococcal infection, you should seek medical attention:

• Persistent Fever: Consider evaluation for fever that persists despite initial treatment.

• Painful or Swollen Joints: Migrating joint pain involving large joints should be evaluated by a medical professional.

• Chest Pain or Breathlessness: These symptoms can be a sign of heart inflammation.

• Rapid or irregular heartbeat: Don't ignore palpitations or an abnormally rapid heartbeat.

• Uncontrolled Body Movements: Any involuntary movements or poor coordination should be evaluated immediately.

• Skin Rash or Nodules: Unexplained rashes or painless lumps under the skin may indicate rheumatic fever.

• Recent Untreated Strep Throat: If you have symptoms within several weeks of a sore throat, see a doctor right away.

• Recurrent Episodes: If a person who has had rheumatic fever develops new symptoms, he should be evaluated.

How is Rheumatic Fever Diagnosed?

The diagnosis of rheumatic fever is made by doctors based on clinical findings, laboratory investigations, and evidence of a recent streptococcal infection.

How is Rheumatic Fever Managed or Treated?

Treatment of rheumatic fever focuses on eliminating the bacterial infection, reducing inflammation, relieving symptoms, and preventing recurrence.

Common Medicines Used to Treat Rheumatic Fever

Medicines prescribed for treating or managing rheumatic fever include the following:

• Penicillin G, Penicillin V, Amoxicillin (or erythromycin/azithromycin if penicillin-allergic): Destroys any leftover bacteria from Group A Streptococcus and stops any immune-mediated harm from occurring, even in cases where the throat infection has already gone away.

• Aspirin and Naproxen: Treats joint pain, fever, and inflammation caused by acute rheumatic fever.

• Prednisone: Used in the case of severe carditis or lack of improvement using NSAIDs.

• Valproic Acid, Carbamazepine: Assists with controlling jerky muscle movements and coordination issues in people with Sydenham's chorea.

• Benzathine Penicillin G injections (every 3-4 weeks) or Oral Penicillin V: Avoids recurrence of rheumatic fever and reduces the risk of having rheumatic heart disease. It will depend on your age and the extent of heart involvement.

Note: The above-mentioned medicines are prescribed as per the severity of the disease, heart involvement, age, and individual clinical condition. Always consult a qualified healthcare professional before starting, stopping or changing any medication.

Living With Rheumatic Fever: Challenges and Caregiving

Even though rheumatic fever is a relatively short-lived disease, some patients, especially those suffering from RHD or requiring long-term prophylactic use of antibiotics, will have difficulties maintaining their health and living a full life. It is important to have family assistance, ensure medical follow-ups, and take medications regularly to avoid possible problems.

Rheumatic Fever and Rheumatic Heart Disease

Rheumatic heart disease is among the most significant long-term sequelae of rheumatic fever. Chronic inflammation can cause permanent damage to heart valves, especially the mitral valve.

The condition can eventually cause the valve to narrow, leak or both. In severe cases, it can cause heart failure, atrial fibrillation, or stroke or require surgery to repair or replace a valve. Regular follow-up with a cardiologist is important for patients with established valve disease.

Each recurrent episode of rheumatic fever increases the risk of permanent valve damage. Long-term antibiotic prophylaxis is important to prevent recurrence and the development of rheumatic heart disease.

What is the Prognosis for Rheumatic Fever?

With early diagnosis and proper treatment, most patients recover completely from the initial episode of rheumatic fever. But repeated attacks multiply the odds of permanent heart valve damage. The long-term prognosis depends on the severity of carditis, compliance with prophylactic antibiotics, and regular medical follow-up.

Many people with milder variations of rheumatic fever can lead healthy lives, while those with significant rheumatic heart disease may require lifelong monitoring and specialist care.

Can Rheumatic Fever Be Prevented?

Although rheumatic fever itself cannot be prevented directly, prompt treatment of streptococcal throat infections can significantly reduce the risk.

Preventive measures include:

• Seek Medical Help for Sore Throat: Persistent fever and sore throat should be medically evaluated immediately, especially in children.

• Complete Prescribed Antibiotics: Taking the entire course of antibiotics helps to completely get rid of the bacteria.

• Maintain Proper Hygiene: Proper handwashing helps prevent the spread of bacteria.

• Prevent Sharing Personal Items: Avoid sharing drinking bottles and utensils during infections.

• Reduce Household Crowding: Where possible, avoid close living conditions to reduce the risk of transmission.

• Follow-up Visits: Patients with a history of rheumatic fever should have regular medical check-ups.

• Take Preventive Antibiotics as Directed: Long-term use of prophylaxis reduces the risk of recurrence.

• Educate Family Members: Awareness leads to early recognition and treatment of streptococcal infections.

Treatment Cost of Rheumatic Fever in India

The cost of managing rheumatic fever in India differs according to the seriousness of the condition, whether there is heart involvement, the duration of treatment, and whether the patient receives treatment in a government or private facility.

An approximate cost range for different treatment components of rheumatic fever is listed below:

Note: The above cost ranges are approximate and may vary depending on the city, hospital, doctor's experience, and the severity of rheumatic fever. Patients should consult a qualified doctor for an accurate diagnosis and treatment estimate.

Does Health Insurance Cover Rheumatic Fever?

Yes. Generally, health insurance plans in India do cover medically necessary treatment for rheumatic fever, as per the terms and conditions of the policy.

Coverage benefits generally include hospitalisation expenses, diagnostic tests, specialist consultations and medicines, as well as treatment for complications such as carditis or rheumatic heart disease. Waiting periods of up to 3 years for pre-existing conditions may apply if there is a history of rheumatic fever or valve disease before policy purchase.

Critical illness insurance policies typically do not cover uncomplicated rheumatic fever itself. However, they may cover a few serious heart-related complications resulting from rheumatic fever if it is mentioned in the policy document. Therefore, always read the policy documents thoroughly before buying.

How Much Health Insurance Coverage is Needed for Rheumatic Fever Treatment?

The amount of health insurance coverage needed for rheumatic fever depends on the severity of the disease, whether or not the heart is involved, the treatment required, and the city where medical care is obtained. In many cases, health insurance coverage of about ₹5 lakh to ₹10 lakh can help cover the costs of hospitalisation, diagnostic tests, specialist consultations, medicines, and follow-up care.

Some patients develop rheumatic heart disease, which may require repeated hospitalisation, long-term cardiac monitoring, and valve repair or valve replacement surgery. In such cases, a higher cover of ₹15 lakh to ₹20 lakh may be considered, especially when treatment is expected at tertiary cardiac centres.

Comparing different health insurance plans is recommended to find coverage that meets future health care needs.