Rheumatic Fever: Causes and Treatment

Understanding Rheumatic Fever: Causes, Symptoms, and Treatment

Rheumatic fever is a systemic inflammatory disease that can develop as a complication of untreated or poorly treated streptococcal throat infection (pharyngitis). It predominantly affects children between the ages of 5 and 15 but can also occur in adults. The condition is characterized by an autoimmune response, where the body’s immune system mistakenly attacks its own tissues, particularly the heart, joints, skin, and central nervous system. This article delves into the causes, symptoms, diagnosis, treatment, and long-term implications of rheumatic fever.

Causes and Pathophysiology

Rheumatic fever is primarily caused by an infection with Group A Streptococcus (GAS), a bacterium responsible for strep throat and skin infections. If strep throat is not adequately treated with antibiotics, the bacteria can trigger an inappropriate immune response. The mechanism involves molecular mimicry, where the streptococcal antigens resemble certain host tissues. This similarity leads the immune system to attack both the bacteria and the body’s own cells, resulting in inflammation.

The risk factors for developing rheumatic fever include:

• Age: Most common in children aged 5-15.
• Geographical location: Higher prevalence in developing countries with limited access to healthcare.
• Previous rheumatic fever: Individuals with a history are at increased risk.
• Socioeconomic status: Crowded living conditions and poor hygiene can facilitate the spread of streptococcal infections.

Symptoms

The symptoms of rheumatic fever can vary widely and may not appear until several weeks after the initial throat infection. Common manifestations include:

1. Fever: A high fever is often present, signaling inflammation.
2. Joint Pain: Migratory arthritis is typical, affecting large joints like knees, ankles, elbows, and wrists. Pain may shift from one joint to another.
3. Heart Involvement: Carditis can occur, leading to inflammation of the heart muscle, valves, or pericardium. Symptoms may include chest pain, palpitations, and shortness of breath.
4. Skin Rash: A characteristic rash known as erythema marginatum may develop, presenting as red, raised areas with pale centers.
5. Chorea: This neurological symptom, also known as Sydenham’s chorea, involves involuntary movements and emotional disturbances.

Other symptoms can include fatigue, abdominal pain, and fever.

Diagnosis

Diagnosing rheumatic fever involves a combination of clinical assessment and laboratory tests. The Jones Criteria are commonly used to establish a diagnosis, requiring evidence of a preceding streptococcal infection alongside certain major and minor manifestations:

• Major criteria:

  • Carditis
  • Polyarthritis
  • Chorea
  • Erythema marginatum
  • Subcutaneous nodules

• Minor criteria:

  • Arthralgia (joint pain)
  • Fever
  • Elevated acute phase reactants (such as ESR or CRP)
  • Prolonged PR interval on ECG

Laboratory tests may include throat cultures, rapid antigen detection tests, and serological tests to detect streptococcal antibodies (e.g., ASO titer).

Treatment

The primary goals in treating rheumatic fever are to eliminate the streptococcal infection, manage inflammation, and prevent complications. Treatment protocols typically involve:

1. Antibiotics: Penicillin or other suitable antibiotics are administered to eradicate any residual streptococcal bacteria.

2. Anti-inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen are used to reduce inflammation and alleviate joint pain. Corticosteroids may be prescribed for severe cases, particularly when carditis is present.

3. Symptomatic Treatment: Additional therapies may address specific symptoms, such as anticonvulsants for chorea or heart medications for carditis.

4. Prophylaxis: Long-term antibiotic prophylaxis is critical to prevent recurrence, especially in individuals with a history of rheumatic fever or rheumatic heart disease. This may involve regular injections of benzathine penicillin G.

Long-term Implications

Rheumatic fever can have lasting effects, particularly when it involves the heart. Rheumatic heart disease (RHD) is a significant complication that arises when the heart valves are damaged, leading to long-term issues such as:

• Valve Stenosis: Narrowing of the heart valves, impeding blood flow.
• Valve Regurgitation: Leaking valves causing blood to flow backward.
• Heart Failure: Resulting from cumulative damage to heart function.
• Increased Risk of Infective Endocarditis: Due to damaged heart valves.

Patients with a history of rheumatic fever require lifelong monitoring and prophylactic measures to mitigate these risks.

Prevention

Preventing rheumatic fever primarily involves timely treatment of streptococcal infections. Public health initiatives focusing on education about recognizing symptoms of strep throat, promoting good hygiene practices, and ensuring access to medical care are crucial in reducing the incidence of rheumatic fever, particularly in at-risk populations.

Conclusion

Rheumatic fever remains a significant health issue in many parts of the world, especially where access to healthcare is limited. Understanding the causes, symptoms, and long-term effects of this condition is vital for effective prevention and management. Continued public health efforts and awareness are essential to reduce the burden of rheumatic fever and its complications, particularly rheumatic heart disease. Early recognition and treatment of streptococcal infections can play a critical role in safeguarding the health of vulnerable populations.