Rheumatic Fever - Sore Throat, Arthritis and Heart Disease

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Category: Other Autoimmune Diseases Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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Ashleigh, a ten–year-old girl, developed strep throat a few weeks ago.  During the past several days, she has had migrating joint pain in her elbows, knees, and ankles. Her mother brought her to her family doctor, who upon physical examination noted a heart murmur.  Her diagnosis:  rheumatic fever.  Her treatment:  aspirin for joint pain and penicillin to eliminate the streptococcus and to prevent further damage to her heart.

Many people may not be familiar with the term “rheumatic fever”.  Generally uncommon in the United States because of our decent living conditions and of the availability of antibiotics, rheumatic fever usually follows a streptococcal infection.  Unfortunately, in less developed countries, rheumatic fever remains a major cause of serious joint and heart disease.

Rheumatic fever can begin with a simple sore throat.  Within two or three weeks after the initial infection, joint pain or swelling can form, moving from one joint to another (migrating arthritis), as well as a red skin rash, inflammation of the heart, rare skin nodules, and uncontrolled movement of the extremities. Even though rheumatic fever occurs primarily in children between the ages of four and fifteen, adults can occasionally be affected.

Triggered by streptococcus, rheumatic fever is an autoimmune disease where susceptible patients develop antibodies that attack not only the infection-causing-bacteria, but also normal and healthy heart and joint tissue.  If rheumatic fever is left untreated, damage to the heart, including possibly permanent scarring of the heart valves and disruption of their function can occur.  Fortunately, not every case of strep throat leads to rheumatic fever, and not every person is susceptible to this disease. It’s like the luck of the draw.  It can happen to a person (specific genetic background) who is in the wrong place at the wrong time (specific strain of streptococcus).

As in Ashleigh’s case, associated joint inflammation is usually treated with non-steroidal anti-inflammatory drugs (NSAIDs), most commonly aspirin.  However, more severe cases may require corticosteroids such as Prednisone.  If you’ve had rheumatic fever, you may be treated with antibiotics (penicillin) for several months, or sometimes indefinitely, to help prevent a recurrence of the disease, especially if you have evidence of heart involvement.

While healthy body function can usually clear bacteria out of the bloodstream easily and quickly, people with damaged heart valves are more susceptible to infection and require special precautions such as starting antibiotics prior to dental and medical procedures.

Even though rheumatic fever is not common in current times, it cannot be overlooked.  When the disease is treated promptly, chances for a full recovery without any long term joint or heart disease are good.

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