Rheumatic fever - Treating rheumatic fever

If your child develops rheumatic fever, they will be referred to a paediatrician by your GP.

Because of the very rare nature of rheumatic fever in England, they may also be referred to a doctor with previous experience of treating this condition so a treatment plan can be drawn up.

This may involve visiting a hospital or specialist clinic in one of the larger cities in England.

Most people with rheumatic fever are well enough to be treated at home, but they may need to make regular hospital visits so the state of their heart can be monitored.

Treatment plan

There is currently no cure for rheumatic fever, but it is possible to make your child feel as comfortable as possible while reducing the risk of serious complications.

This can be achieved by:

• using anti-inflammatory medications to relieve symptoms 
• using antibiotics to clear out any remaining streptococcus bacteria in your child’s body
• plenty of bed rest

Anti-inflammatory medications

Anti-inflammatory medications can be used to relieve symptoms of joint pain, swelling (arthritis) and, in severe cases, reduce inflammation of the heart.

Non-steroidal anti-inflammatory drugs (NSAIDs), which include painkillers such as ibuprofen, are commonly used to relieve arthritis.

The use of aspirin is not usually recommended in children under the age of 16 as there is a very small risk of causing Reye’s syndrome – a potentially fatal condition that can cause liver and brain damage.

However, an exception is usually made for rheumatic fever, as most children are only required to take a low-dose aspirin for one to two weeks, and it has proved extremely successful in relieving symptoms. Most health professionals believe the benefits of aspirin in the treatment of rheumatic fever far outweigh the risks.

If the results of your electrocardiogram (ECG) show inflammation of the heart, a type of steroid medication called prednisolone will usually be recommended.

Prednisolone is usually given in tablet form for a course of two to six weeks.

Side effects of prednisolone include headache, dizziness, problems sleeping and weight gain.

These side effects should pass once the course is finished. 

Antibiotics

It is important to get rid of any streptococcus bacteria left in your child’s body from the infection. It's also important to prevent any streptococcus bacteria picked up after the initial infection from settling in the throat and causing another infection (known as prophylaxis). This is because further throat infections may lead to another episode of rheumatic fever.

Repeated episodes of rheumatic fever increases the risk of causing permanent damage to the heart.

Injections of antibiotics (intravenous antibiotics) every two to three weeks over the course of many years is usually recommended.

The current recommendations are:

• if your child did not experience any inflammation of the heart, the course should last for five years or until your child is 18 (whichever is longer)
• if your child did experience inflammation of the heart but their heart recovered, the course should last for 10 years or until your child is 25 (whichever is longer)
• if your child had inflammation of the heart that caused significant, persistent heart disease, the course should last until they are at least 40-45 (some doctors have recommended that the course should last for the rest of their life)

Bed rest

Plenty of bed rest is recommended, as this will help reduce the strain on the heart and help ease some of the symptoms, such as shortness of breath and constantly feeling tired.

As your child begins to recover, they can slowly increase their activity levels.

The doctor in charge of your child’s care will be able to make more detailed recommendations.

Sydenham chorea

If your child is experiencing episodes of Sydenham chorea (uncontrollable physical jerking and emotional outbursts), moving them into a calm, quiet environment, such as a darkened bedroom, can help improve their symptoms.

If these episodes are more severe, medication may be recommended. Medicines originally designed to treat epilepsy, such as carbamazepine and valproic acid, are usually effective in treating Sydenham chorea.

If the dose is too high, these medicines can cause side effects similar to being drunk, including dizziness, double vision and vomiting.  

If your child experiences any of these symptoms, contact the doctor in charge of their care so that the dosage can be revised.