Rheumatic Fever: Symptoms, Diagnosis, Treatment, and Prevention

Rheumatic fever is a health condition to watch out for, because it can affect the heart and the body’s overall health. Although it is often thought of as a rare disease, rheumatic fever is still a problem in many countries, including Indonesia.

Global epidemiological data show that the incidence of rheumatic fever has declined significantly in developed countries compared with developing countries. This decline is linked to various factors, such as improved socioeconomic conditions, better access to health facilities, and the availability of treatment.

However, the incidence of rheumatic fever remains high among young people in lower- and middle-income countries, including Indonesia. In developing countries, the disease is often found in densely populated, low-income areas. Global data show that there are about 33 million rheumatic fever patients worldwide, with 300,000 to 500,000 new cases each year and about 230,000 deaths from long-term complications. The annual incidence of rheumatic fever ranges from less than 0.5 cases per 100,000 people in developed countries to more than 100 per 100,000 people in developing countries.

In Indonesia, although national epidemiological data on rheumatic fever are not yet available, its complications still need attention. That is why a quick response and public education are key to preventing and managing this disease so that it does not cause permanent heart damage.

01 / Heart Disease

What Is Rheumatic Fever?

Rheumatic fever is an inflammatory reaction that occurs in the body in response to a bacterial throat infection. It mainly affects the cardiovascular system, joints, skin, and nervous system. Although it is more common in children aged 5 to 15 years, rheumatic fever can affect anyone who has had a throat infection that was not properly treated.

02 / Heart Disease

Causes of Rheumatic Fever

The main cause of rheumatic fever is infection with Group A Streptococcus (GAS) bacteria, which usually causes a sore throat or pharyngitis. If this infection is not treated, the immune system can overreact and end up making body tissues such as the heart, joints, and skin the “target” of that reaction. This leads to inflammation that can cause the symptoms of rheumatic fever.

After a throat infection with GAS bacteria, the body starts producing antibodies to fight the bacteria. However, in some cases, these antibodies attack not only the bacteria but also healthy body tissue, because there is a structural similarity between the bacteria and some cell components in the body. This process is known as an autoimmune reaction, in which the body attacks itself. As a result, inflammation occurs in various parts of the body, such as the heart, joints, and skin, causing the typical symptoms of rheumatic fever. This inflammatory process can cause long-term damage, especially to the heart, if it is not managed properly.

03 / Heart Disease

Symptoms of Rheumatic Fever

If left untreated, rheumatic fever can lead to serious complications. Recognizing its symptoms as early as possible is very important to prevent permanent damage, especially to the heart.

Common Symptoms

Symptoms of rheumatic fever can vary, but some common signs that often appear include:

1. High fever: A significant rise in body temperature, often accompanied by heavy sweating and discomfort.
2. Joint pain: Pain and swelling in the joints, which may move from one joint to another. This often occurs in large joints such as the knees, wrists, and elbows.
3. Skin rash (erythema marginatum): Ring-shaped reddish patches on the skin that are not always itchy. This rash usually appears in certain areas and may fade over time.

Specific Symptoms

Besides the common symptoms, there are several specific symptoms to watch for:

1. Carditis: Inflammation of the heart that can cause chest pain, shortness of breath, or an irregular heartbeat. Carditis is a serious complication of rheumatic fever and can have a long-term impact on heart health.
2. Chorea (Sydenham chorea): A condition with uncontrolled body movements, especially in the hands and feet. These movements can look strange and uncontrolled, and they are often more noticeable when the person tries to move.
3. Subcutaneous nodules: Small lumps that form under the skin, most commonly found around the joints. These nodules usually do not hurt and may disappear over time.

The Importance of Detecting Symptoms Early

Early detection of rheumatic fever symptoms is very important to prevent serious complications. If symptoms such as high fever, joint pain, or a rash appear after a throat infection, consult a health professional right away.

Prompt and appropriate treatment can reduce the risk of heart damage and support a better quality of life. By paying attention to our health and recognizing these symptoms, we can take the necessary preventive steps to stay healthy, especially for children and teenagers, who are at higher risk of rheumatic fever.

04 / Heart Disease

Diagnosing Rheumatic Fever

Diagnosing rheumatic fever requires a careful process. An accurate diagnosis is not based on symptoms alone; it requires the right medical examinations. This section explains how doctors diagnose rheumatic fever, from the physical examination to the supporting tests needed, so that the right treatment can be given as early as possible.

1. The Role of the Physical Examination

A physical examination is a very important first step in diagnosing rheumatic fever. The doctor will check for physical signs such as joint swelling, skin rash, and abnormal heart sounds that may indicate inflammation. Through the physical examination, the doctor can also assess how severe the symptoms are and decide on the next steps for a more accurate diagnosis.

2. Supporting Tests

Besides the physical examination, several supporting tests are also needed to help diagnose rheumatic fever, including:

• Blood tests: These tests aim to detect certain antibodies, such as Anti-Streptolysin O (ASO) or Anti-DNase B, which indicate a previous streptococcal infection. High levels of these antibodies may indicate that the body is reacting to a past infection.
• ECG (electrocardiogram): An ECG is done to monitor the heart’s electrical activity and can help detect heart problems that may be caused by carditis.
• Echocardiography: An echocardiography or echocardiogram test uses sound waves to produce images of the heart. With echocardiography, the doctor can assess the heart’s condition and see whether there is inflammation or damage to the heart valves caused by rheumatic fever.

3. Jones Criteria for Diagnosing Rheumatic Fever

The Jones criteria are guidelines used to diagnose rheumatic fever. These criteria include major symptoms such as carditis, joint pain, chorea, and subcutaneous nodules, as well as additional symptoms such as skin rash. To diagnose rheumatic fever, at least two major symptoms, or one major symptom with evidence of a previous streptococcal infection, are usually required. Using these criteria helps doctors determine whether a patient truly has rheumatic fever and needs further care.

05 / Heart Disease

Treating Rheumatic Fever

Rheumatic fever requires prompt and appropriate treatment to prevent serious complications. This section discusses the various treatment methods for rheumatic fever, from antibiotics to other supportive care, so that you can understand the important steps in the healing process.

1. Antibiotics to Kill GAS Bacteria and Prevent Further Damage

Treatment for rheumatic fever begins with antibiotics, especially penicillin. This antibiotic is effective in killing the Group A Streptococcus (GAS) bacteria that cause the infection. By treating this infection, we can prevent further damage to the heart and other organs.

Antibiotic treatment is usually given for a period determined by the doctor to make sure the bacteria are fully eliminated.

2. Anti-Inflammatory Drugs to Relieve Symptoms

To manage symptoms such as joint pain, swelling, and fever, anti-inflammatory drugs are an important part of treatment. Aspirin is often used because it can relieve pain and inflammation. In more severe cases, the doctor may prescribe corticosteroids to suppress the inflammatory reaction and provide quick relief for the patient.

3. Supportive Care

Besides the main treatment, supportive measures are also very important to help the healing process. Getting enough rest helps the body recover from inflammation. A healthy, nutrient-rich diet is also important to strengthen the immune system and support recovery.

In addition, proper pain management can help the patient feel comfortable, either with pain relievers or other techniques recommended by the doctor.

Treatment for rheumatic fever does not stop once the symptoms subside. Long-term treatment is very important to prevent recurrence. Prophylactic antibiotics, usually given for several years, may help protect the patient from repeat infections that can trigger another episode of rheumatic fever. Regular monitoring by a doctor is also needed to make sure there are no further complications and to detect other potential health problems.

06 / Heart Disease

Preventing Rheumatic Fever

Prevention is better than cure. Although there is no specific vaccine, the right preventive steps can significantly reduce the risk of getting this disease.

1. Preventing GAS Infection

One of the main steps in preventing rheumatic fever is preventing infection with Group A Streptococcus (GAS) bacteria. If someone has symptoms of a throat infection, it is important to get the right antibiotic treatment promptly. By treating throat infections effectively, we can reduce the risk of rheumatic fever developing from the body’s reaction to these bacteria. Completing the full course of antibiotics prescribed by the doctor is also very important so that the infection is fully cleared.

2. Vaccination

Vaccination can be one preventive step, although there is currently no specific vaccine against rheumatic fever itself. However, vaccination against other infections that can affect overall health, such as the flu vaccine, is still important. By keeping our overall health in good shape, we can reduce the chance of complications from infections that could potentially lead to rheumatic fever.

07 / Heart Disease

Complications of Rheumatic Fever

Rheumatic fever that is untreated or treated late can lead to serious complications, especially in the heart. This section explains in detail the various complications that may result from rheumatic fever, so that you can understand the importance of early detection and proper treatment.

1. Permanent Heart Damage (Rheumatic Heart Disease)

One of the most serious complications of rheumatic fever is permanent heart damage, known as rheumatic heart disease. This condition occurs when inflammation from rheumatic fever damages heart tissue, especially the heart valves. This damage can prevent the heart valves from working properly, which carries a risk of various heart health problems later in life.

2. Heart Failure

Heart failure is another serious complication that can be caused by rheumatic heart disease. When the heart cannot pump blood effectively because of damage to the valves or heart muscle, symptoms such as shortness of breath, fatigue, and swelling in the legs can appear. Heart failure is a chronic condition that requires long-term care and management to improve the patient’s quality of life.

3. Heart Valve Problems

Heart valve problems occur when the heart valves, which regulate blood flow within the heart, are damaged by inflammation. This can cause a valve to narrow (stenosis) or leak (insufficiency), both of which can disrupt normal blood flow. Heart valve problems often require specialized medical treatment, such as medication or even surgery to repair or replace the damaged valve.

08 / Heart Disease

Conclusion

In this article, we have discussed various important aspects of rheumatic fever, from its definition, symptoms, diagnosis, treatment, and prevention to the complications that may occur. Rheumatic fever, which is caused by Streptococcus bacterial infection, can lead to various serious health problems, especially in the heart, if it is not managed properly. Prompt diagnosis and appropriate treatment, including antibiotics and anti-inflammatory drugs, are essential to prevent further damage.

The importance of responding quickly to the symptoms of rheumatic fever cannot be overlooked. By recognizing the early signs and getting medical care right away, we can reduce the risk of complications that can affect quality of life in the long term. Education and awareness of this condition will help the public be better prepared and more responsive in dealing with rheumatic fever. With the right preventive steps, our heart health and quality of life can be well maintained.

Remember that the information in this article is for educational purposes and is not a substitute for professional medical advice. If you have symptoms of rheumatic fever or heart disease, consult a specialist right away or visit Heartology Cardiovascular Hospital for proper evaluation and care.

At Heartology Cardiovascular Hospital, our team of cardiologists can explain your condition and the procedures, risks, and benefits of treatment, and discuss your questions about heart and blood vessel health.