Rheumatic fever is an inflammatory condition. It involves the connective tissue in the body. The most severe complication is rheumatic heart disease. This condition may permanently damage the heart valves. Valves affects the flow of blood to and from the heart. Symptoms of valve damage often don't appear for 10-30 years after the initial event.

Rheumatic fever is caused by a problem in the immune system. It happens in response to group A Streptococcus pharyngitis ( strep throat ). In this case, the immune system not only fights the bacteria but also attacks its own tissue. It often attacks heart tissue.

Factors that may increase your risk of rheumatic fever include:

• Age: 5 to 15 years old
• Previous case of rheumatic fever
• Malnutrition
• Overcrowded living conditions

Symptoms usually appear 2 to 4 weeks after a strep infection. They may include:

• Pain and swelling in large joints
• Fever
• Weakness
• Muscle aches
• Shortness of breath
• Chest pain
• Nausea and vomiting
• Hacking cough
• Circular rash
• Lumps under the skin
• Abnormal, sudden movements of arms and legs

The doctor will ask about your symptoms and medical history. A physical exam will be done. This will include a careful exam of your heart. The doctor may take a throat culture. A blood test for streptococcal antibodies may be done.

Other tests may include:

• Other blood tests—such as erythrocyte sedimentation rate to measure inflammation in the body, and blood cultures for bacteria in the blood
• Electrocardiogram —a test that records the heart's activity by measuring electrical currents through the heart muscle
• Echocardiogram —a sonogram which visualizes the heart valves, and measures the contractile function of the heart muscle
• Chest x-rays —a test that uses radiation to take a picture of structures inside the body, in this case the heart

The goals of treatment are to:

• Kill the strep bacteria
• Treat the inflammation caused by the rheumatic fever
• Prevent future cases of rheumatic fever

Treatment may include:

To treat the strep infection:

• Penicillin or other antibiotics (eg, erythromycin and azithromycin )
• Antibiotics may need to be taken for several years to prevent recurrence
• May be given by mouth or injection

To help with joint pain and swelling:

• Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids may be used if NSAIDs are not effective

In some cases the inflammation can be severe. You may have to be on bed rest or restricted activity for a period of time.