What is rheumatic fever?

Rheumatic fever is an inflammatory disease that may develop after a streptococcal infection such as a sore throat (‘strep’ throat). Treatment for rheumatic fever includes antibiotics and rest, and children may need to go to hospital. Regular antibiotics are usually needed for some years afterwards to stop the disease coming back. Rheumatic fever can cause permanent damage to a child’s heart valves – rheumatic heart disease.

Who gets rheumatic fever and what are the symptoms?

Rheumatic fever mainly affects children aged between five and 14 years.

A few weeks after having the streptococcal infection ('strep' throat) your child may develop:

• sore or swollen joints (knees, elbows, ankles and wrists)
• a skin rash
• a fever
• stomach pain
• jerky movements.

How can rheumatic fever affect the heart?

If your child has a bad attack of rheumatic fever it may cause permanent damage to their heart valves. This is called rheumatic heart disease.

A heart valve acts like a one-way door. It makes sure that blood pumped by the heart flows in one direction only.

 When the heart valve is damaged it can cause:

• breathlessness
• tiredness.

Can rheumatic fever be prevented?

Rheumatic fever can be prevented by prompt diagnosis of a strep throat and treatment with antibiotics.

Will the symptoms of rheumatic fever go away?

Most of the acute symptoms of rheumatic fever, such as: sore or swollen joints (knees, elbows, ankles and wrists), a skin rash, a fever, stomach pain and jerky movements, will go away in time. However, damage to the heart valves - rheumatic heart disease - may be permanent.

How is rheumatic fever treated?

Children with rheumatic fever are often treated in hospital, depending on the severity of the disease. In most cases, treatment involves:

• antibiotics - the immediate goal is to treat the streptococcus infection with antibiotics; your child may continue to receive monthly doses of antibiotics after the initial treatment to help prevent further complications
• anti-inflammatory medications - depending on the severity of your child's condition, the doctor may prescribe medication to help decrease swelling that occurs in the heart muscle, as well as to relieve joint pain
• bed rest - the length of bed rest will be determined by your child's doctor, based on the severity of disease; bed rest may range from two to 12 weeks.

What if my child also has rheumatic heart disease?

If your child has damage to their heart valve they:

• may need to stay in hospital for longer
• have penicillin injections for much longer
• will need special care when visiting the dentist or dental therapist (nurse) 
• may eventually need surgery to repair the damaged valve.

Your doctor or nurse will speak to you about the care and treatment your child needs while they are in hospital.

What care will my child need at home?

Your child will still need to take it easy when he or she goes home. They will also need to have ongoing penicillin injections to prevent another attack. Another antibiotic, eg. erythromycin, will be given to people who are allergic to penicillin.

It is very important that your child does not get rheumatic fever again.  Another attack could cause long term damage to the heart and heart valves.

How can I stop my child having another attack of rheumatic fever?

The best way to stop your child having another attack of rheumatic fever is to make sure they have regular penicillin injections - on time.

Penicillin injections:

• must be given every 28 days
• are given in your child's thigh or bottom
• can be painful at first but children quickly get used to them
• are given by your Community Nurse, District Nurse or Public Health Nurse. They will come to your home or your child's school and give the injection.

How long will my child need to have penicillin injections?

Your doctor will advise how long your child needs to have penicillin injections. As a general guide, your child may need to have injections for 10 years or until they are 21 years old, whichever is longer. If your child has damage to their heart valve they may need injections for 10 years or until they are 30 years old, whichever is longer.

This may seem like a long time but if your child doesn't have these injections they could have another rheumatic fever attack.

Your doctor will tell you when it is safe for your child to stop having the penicillin injections.

What if my child misses or forgets an injection?

It is very important that your child does not miss an injection. If they do, then you must arrange for them to get the next injection as soon as possible.

Remember to tell your doctor or nurse if your child is going overseas, on holiday, away for a while, or you are moving house. They can then arrange ongoing treatment for your child.

Your child should never stop penicillin treatment without discussing this first with your doctor.

Will my child be able to lead a normal life?

With proper care and regular penicillin injections, most children with rheumatic fever lead a normal life. The most important thing is to make sure your child never has another attack of rheumatic fever. The only way you can do this is to make sure they have their regular penicillin injections.

What else do I need to do if my child has rheumatic heart disease?

Teeth and dental health: You need to tell your child's dentist or dental therapist (nurse) that your child has rheumatic heart disease because your child will need extra antibiotics by mouth before some types of dental treatment.

When the dentist is working on your child's teeth, tiny bugs in the mouth (we all have them) can get into the bloodstream. The blood will carry these bugs to the heart and may cause further damage to the heart valves. This is called infective endocarditis.

You need to help your child to look after their teeth and avoid any infection. Make sure that they:

• brush their teeth twice a day with fluoride toothpaste
• don't have sweet food and drinks too often 
• have dental checks every six months.

Medical procedures: You need to tell your child's doctor if they are having a medical procedure - there is an increased risk to them if they get an infection.

Pregnancy: Your daughter should continue having penicillin injections during pregnancy until her doctor says they are no longer needed.

Other common questions and answers about rheumatic fever

What happens when my child finishes having injections?

Your doctor will tell you when it is safe for your child to stop having the penicillin injections.

When your child gets a sore throat, they will need to have a check-up to see if they have a 'strep' throat. If they do, it will have to be properly treated.

What about diet and rheumatic fever?

Because rheumatic fever can affect the heart, it is important not to add further stress on the heart, either by smoking or being overweight.

To help your child, make sure they eat a healthy diet.

Is rheumatic fever catching?

You cannot 'catch' rheumatic fever from another person, but 'strep' throats can be passed on to others by breathing or coughing over them.

Does rheumatic fever run in the family?

There is no real evidence that rheumatic fever runs in the family. However, some families get rheumatic fever more than others. Members of those families should make sure that when they get a sore throat they go to the doctor for a check up.  If it is a 'strep' throat they can get it properly treated.

How to treat sore throats to prevent rheumatic fever

If your child or anyone in your family gets a sore throat:

• go to their doctor and ask for a throat swab.
• have a throat swab done and check if it is a 'strep' throat.
• The doctor will either give:
     - a course of penicillin tablets (people allergic to penicillin will be given an alternative, eg, erythromycin). These tablets must be started straight-away and taken for 10 days (even if the sore throat feels better after 2-3 days).
     - or one injection of penicillin.

Your doctor will inform you if it is not a 'strep' throat.

Original material provided by the Heart Foundation of New Zealand, November 2008. Edited by everybody, January 2011.