Rheumatic fever - Symptoms of rheumatic fever

The symptoms of rheumatic fever usually develop one to five weeks after a streptococcal throat infection.

Common symptoms

Common symptoms of rheumatic fever are described below.

Arthritis

Pain and swelling of the joints (arthritis) is the most common symptom, affecting three out of four people.

The larger joints, such as the knees, ankles, elbows and wrists are usually affected, typically on both sides of the body. Normally, several joints are affected at the same time.

The symptoms of arthritis should pass within four weeks as the inflammation settles, without causing any permanent damage.

Inflammation of the heart (carditis)

Inflammation of the heart (carditis) is another common and potentially serious symptom of rheumatic fever.

Carditis occurs in an estimated 30-60% of people with rheumatic fever and is more common in younger children.

Because of the inflammation, the heart has difficulty pumping blood around the body, which can cause the following symptoms:

shortness of breath, especially when a person is physically active or when sleeping (this can often wake a person up, gasping for breath)
persistent cough
rapid heartbeat (tachycardia)
feeling tired all the time
chest pain

Carditis can persist for several months, but it should improve over time.

Sydenham's chorea

Sydenham's chorea is a term used to describe a collection of symptoms related to inflammation of the nerves. These symptoms are:

involuntary and uncontrollable jerking and twitching of the body – most often, the hands and feet
difficulties with tasks requiring fine hand movements, such as writing
difficulties with balance
unusual emotional outbursts, such as crying or laughing for no apparent reason

Around in one in four children with rheumatic fever will develop Sydenham's chorea, but it is very rare in adults.

Sydenham's chorea usually passes within a few months and should not cause any permanent damage to the nervous system. However, there have been some reports of it persisting for up to two years.

Skin rash

Around 1 in 10 children with rheumatic fever will develop a skin rash, known as erythema marginatum. The rash is usually painless, non-itchy and spreads slowly over the child’s body. It may only be noticeable in fair-skinned children.

The rash will normally come and go over a few weeks or months, before going away altogether.

It is very rare for adults with rheumatic fever to develop a skin rash.

Less common symptoms

Less common symptoms of rheumatic fever include:

subcutaneous skin nodules – small painless bumps or lumps under the skin, usually found on the wrists, elbows and knees
a very high temperature (fever) of 39°C (102°F) or above
abdominal pain
nosebleeds