What is rheumatic fever?

Acute rheumatic fever (ARF) is an illness that follows a skin or throat infection caused by group A streptococcus. These bacteria are also called GAS or strep A.

Strep A bacteria can cause infection in your:

• throat — strep throat
• skin — skin sores, pyoderma, impetigo

Rheumatic fever is an autoimmune condition that can affect different parts of your body including the heart, joints, brain and skin.

What are the symptoms of rheumatic fever?

Rheumatic fever symptoms usually appear 2 to 6 weeks after a Strep A infection.

Symptoms of rheumatic fever can vary between people. They can range from very mild to severe and may include:

• fever
• painful or swollen joints
• jerky movements of the hands, legs, tongue and face
• chest pain
• a rash on your chest, arms or legs (although this is rare)
• lumps on your elbows, wrists, knees, ankles and spine (this is also rare)
• feeling tired and muscles aches

What causes rheumatic fever?

Rheumatic fever is caused by your body's immune response to the Strep A infection.

In some people, the body's immune system gets confused, and they have an autoimmune reaction to the infection.

An autoimmune reaction is when your immune system mistakenly attacks healthy tissue. This causes inflammation, which causes the symptoms of rheumatic fever.

Who is at risk of rheumatic fever?

In Australia, rheumatic fever is more likely to affect:

• Australia's Aboriginal and/or Torres Strait Islander peoples
• New Zealand Maori and Pacific Islanders

Rheumatic fever is:

• most common in children aged 5 to 14 years
• more common in females than males

You're at increased risk of rheumatic fever if:

• you've had it before
• you live in a rural or remote location in northern Australia
• you live in crowded housing

When should l see my doctor?

See your doctor if you are sick and have:

• a sore throat
• a skin infection
• fever and sore joints

Anybody who is in a high risk group should see their doctor if they have any of the symptoms listed above.

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How is rheumatic fever diagnosed?

Your doctor will talk with you about your symptoms and will examine you. They may arrange tests, including:

• blood tests
• a throat swab
• an echocardiogram (heart ultrasound)

These tests can help your doctor find out if you are likely to have rheumatic fever.

There is no single test used to diagnose rheumatic fever.

How is rheumatic fever treated?

If your doctor thinks you have rheumatic fever, you will usually be treated in hospital. In hospital, a multidisciplinary team (team of health care professionals) can look after you.

Your treatment will include:

• monitoring, for example with blood tests and ECGs
• antibiotics for the Strep A infection
• rest
• pain management
• treatment for your other symptoms

You may be given paracetamol to reduce fever and relieve sore joints. Other medicine may be recommended to reduce inflammation of your heart. You may also be given medicine to reduce any jerky movements you're having.

Long-term treatment includes:

• regular, long-term antibiotics
• prompt treatment of sore throats and skin sores
• stopping the development or progression of rheumatic heart disease

How can rheumatic fever be prevented?

You can help prevent rheumatic fever by seeing the doctor or nurse when you're sick.

If you have a Strep A infection, it’s important to avoid spreading it to others. Stay away from other people as much as you can, and keep up good hygiene practices.

What are the complications of rheumatic fever?

The main complication of rheumatic fever is rheumatic heart disease (RHD).

RHD is when your heart valves are damaged due to the inflammation caused by rheumatic fever.

Treatment with antibiotics can help stop you from developing advanced RHD or needing heart surgery.

People living with advanced RHD need medical care and follow up for the rest of their lives.

Resources and support

The Heart Foundation has information on acute rheumatic fever and rheumatic heart disease, including a video on prevention.

You can call healthdirect on 1800 022 222 at any time to speak to a registered nurse (known as NURSE-ON-CALL in Victoria) for more information and advice.