Could I Have Rheumatic Fever?

Last December I got strep throat. I’ve had it before. I waited three weeks to go to the doctor. My strep was much worse than it’s ever been before. I had the swollen joints, fever, everything. It was awful, I thought I was going to die, even though I know that sounds silly. Now it’s a year later, and I’m running track for my high school.

Well, trying to run. I feel so weak. I can’t run normal distances like I used to. My body just won’t do it. My heart just aches and aches. I’ve been reading up on rheumatic fever. I’m wondering if I could have a heart condition from the strep last year. Please help. I don’t want to collapse on the track someday.

Rheumatic fever used to be a serious cause of heart disease in young people, and still is common in many underdeveloped countries, although in the United States it has decreased enormously in incidence. Nonetheless, sporadic cases do occur here, and there have been recent reported epidemics in military camps.

Rheumatic fever follows infection by a strain of Group A beta hemolytic streptococci. Not all strains of Group A strep cause the disease, however, and it is thought that some strains stimulate the development of antibodies which, in a susceptible person, trigger the attack of rheumatic fever. In a sense then, it is an autoimmune disease in which antibodies produced by the infected person attack their own tissues. What makes some people susceptible to this has not been discovered, nor is it known which antibodies produce the disease. Rheumatic fever typically starts one to three weeks following a strep sore throat. It does not follow strep infections elsewhere. Timely treatment of a strep throat — that is, within the first four to five days of the infection — will prevent the development of the disease.

It used to be said that rheumatic fever “licks the joints but bites the heart.” The two major manifestations of the disease are arthritis, with true swelling and redness of the joints, and carditis, or inflammation of the heart. The arthritis produces no permanent damage to the joints, whereas the carditis often permanently damages the heart, bringing about scarring of the heart valves, and, less frequently, heart failure due to actual damage to the heart muscle. Surprisingly, these is usually no chest pain from the carditis, unless the sac surrounding the heart is inflamed (pericarditis) and this is not very common. Once one has recovered from the carditis, there should be no chest pain.

Someone with rheumatic fever will almost always show signs of a previous strep infection on a blood test, even if the sore throat is gone. However, there is no single test that makes the diagnosis of rheumatic fever, and a doctor must satisfy a set of criteria known as the Jones critieria in order to make it. These include evidence of arthritis, carditis, a typical skin rash, nodules under the skin, and various laboratory tests. To make the diagnosis one must find two major manifestations or one major and two minor manifestations of the disease. It is customary to treat with penicillin, and the arthritis and carditis are treated with rest and anti-inflammatory drugs like aspirin, or cortisone-type drugs. Although chronic carditis can occur, it would be unusual for it to persist over a year.

Our writer today doesn’t say whether her doctor diagnosed rheumatic fever when she finally saw her after three weeks. I think if she had truly swollen joints as she describes, it would be unlikely for her doctor to miss it, although it is true that many younger doctors have never seen a case of acute rheumatic fever, and might not think of the diagnosis. I also don’t think that rheumatic fever would explain the aches in her heart that she describes now a year later.

It may be too late to make a definite diagnosis in her case, since the blood tests will no longer be positive, but it should be possible to definitely determine whether she has suffered any heart damage. A careful examination, together with an echocardiogram, would allow her doctor to determine if her heart is enlarged, or if any damage has taken place to the heart valves. If the echocardiogram does suggest damage of the type seen in rheumatic fever, then one could make the diagnosis.

This is very important, because once someone has had an attack of rheumatic fever, the chances of another attack following another strep throat are high, perhaps as high as 50 percent, and each subsequent attack risks further damage to the heart valves. For this reason it is now standard practice to give all people who have had one attack regular penicillin shots, monthly, until they are into their twenties or even till they are older. This has been shown to prevent the recurrent strep sore throats and recurrent rheumatic fever.

If our writer has a normal heart on examination and echocardiogram, then I would look elsewhere for a cause of her heart aches and fatigue. She can also be reassured in that case that there is no danger of her collapsing and dying while running track.

The information provided on Health Search Online is for educational purposes only and is not a substitute for medical advice, diagnosis or treatment.