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Symptoms
By Mayo Clinic staffRheumatic fever symptoms may vary. Some people may have several symptoms, while others experience only a few. The symptoms may also change during the course of the disease. The onset of rheumatic fever usually occurs about two to four weeks after a strep throat infection.
Rheumatic fever signs and symptoms — which result from inflammation in the heart, joints, skin or central nervous system — may include:
- Fever
- Painful and tender joints — most often the ankles, knees, elbows or wrists; less often the shoulders, hips, hands and feet
- Pain in one joint that migrates to another joint
- Red, hot or swollen joints
- Small, painless nodules beneath the skin
- Chest pain
- Sensation of rapid, fluttering or pounding heartbeats (palpitations)
- Fatigue
- Shortness of breath
- Flat or slightly raised, painless rash with a ragged edge (erythema marginatum)
- Jerky, uncontrollable body movements (Sydenham chorea or St. Vitus' dance) — most often in the hands, feet and face
- Outbursts of unusual behavior, such as crying or inappropriate laughing, that accompanies Sydenham chorea
When to see a doctor
Your child should see a doctor if he or she has signs or symptoms of strep throat. Proper treatment of strep can prevent rheumatic fever. Call your doctor if your child has any of the following signs or symptoms:
- A sore throat without cold symptoms, such as a runny nose
- A sore throat accompanied by tender, swollen lymph glands (nodes)
- Rash
- Difficulty swallowing anything, including saliva
- Thick or bloody discharge from the nose, which is more likely in children under 3 years of age
Call your doctor about a fever in the following situations:
- Newborns up to 6 weeks with a fever of 100 F (37.8 C)
- Children ages 6 weeks to 2 years with a temperature of 102 F (38.9 C) or higher
- Children age 2 or older with a fever of 103 F (39.4 C) or higher
- Any fever that lasts more than three days
Also, see your doctor if your child shows any other signs or symptoms of rheumatic fever.
- Fort GG. Rheumatic fever. In: Ferri FF. Ferri's Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05610-6..00027-5--sc0105&isbn=978-0-323-05610-6&type=bookPage§ionEid=4-u1.0-B978-0-323-05610-6..00027-5--sc0105&uniqId=224600605-3. Accessed Oct. 28, 2010.
- Rheumatic fever. In: Marx JA, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. St. Louis, Mo.: Mosby; 2009. http://www.mdconsult.com/books/page.do?sid=1075999583&eid=4-u1.0-B978-0-323-05472-0..00081-5--s0050&isbn=978-0-323-05472-0&type=bookPage§ionEid=4-u1.0-B978-0-323-05472-0..00081-5--s0050&uniqId=224600605-4. Accessed Oct. 28, 2010.
- Rheumatic fever. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec19/ch281/ch281a.html. Accessed Oct. 28, 2010.
- Choby B. Diagnosis and treatment of streptococcal pharyngitis. American Family Physician. 2009;79:383.
- Gibofsky A, et al. Epidemiology and pathogenesis of acute rheumatic fever. http://www.uptodate.com/home/index.html. Accessed Oct. 28, 2010.
- Gibofsky A, et al. Treatment and prevention of rheumatic fever. http://www.uptodate.com/home/index.html. Accessed Oct. 28, 2010.
- Report for the second meeting of World Health Organization's subcommittee of the Expert Committee of the Selection and Use of Essential Medicines: Antibiotic use for the prevention and treatment of rheumatic fever and rheumatic heart disease in children. Geneva, Switzerland: Royal Hobart Hospital and University of Tasmania. http://www.who.int/selection_medicines/committees/subcommittee/2/RheumaticFever_review.pdf. Accessed Oct. 28, 2010. Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 3, 2010.
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