Rheumatic Fever

The most common sign of rheumatic fever is arthritis, or inflammation of the joints. Arthritis occurs in 75% of rheumatic fever patients. The arthritis is extremely painful and involves the larger joints of the body, such as the knee, elbow, wrist, and ankle. Symptoms include tenderness, warmth, severe pain, and redness. The inflammation resolves by itself in two to three weeks with no lasting effects.

Another common sign of rheumatic fever is carditis, or infection of the linings of the heart. Carditis occurs in 40-50% of patients. Often, the aortic (the valve that connects the left ventricle of the heart to the aorta) and mitral (the valve that connects the left atrium and left ventricle) valves become scarred, leading to a condition called stenosis. In stenosis, the delicate leaflets that make up the valve weld together. The valve is essentially "frozen" shut, obstructing the flow of blood through the heart. Carditis and stenosis cause few symptoms but are serious manifestations of rheumatic fever. If the carditis is severe, it may lead to heart failure. Congestive heart failure, in which the heart gradually loses its ability to pump blood, occurs in 5-10% of patients with rheumatic fever.

The third most common sign of rheumatic fever occurring in 15% of patients is chorea, in which the face, hands, and feet move in a rapid, non-purposeful way. Patients with chorea may also laugh or cry at unexpected moments. Chorea disappears within a few weeks or months, but is a particularly distressing sign of rheumatic fever.

The least common sign of rheumatic fever occurring in less than 10% of patients is the appearance of subcutaneous (under the skin) nodules. These nodules are painless and localize over the bones and joints. Nodules may last about a month before they disappear. A skin rash called erythema marginatum is also a sign of rheumatic fever. The rash is ring-shaped and painless, and may persist for hours or days and then recur.