Medicines for Rheumatic fever

What it is

Rheumatic fever is an illness that can develop as a complication of an untreated or inadequately treated infection with certain streptococcus ("strep") bacteria — usually a strep throat infection (streptococcal sore throat), and sometimes scarlet fever. It is now rare in the UK and many high-income countries (largely because strep throat infections are commonly treated with antibiotics), but it remains more common in some parts of the world. Rheumatic fever is not the infection itself, but an abnormal reaction of the immune system that occurs a few weeks after the strep infection, in which the immune response ends up affecting other parts of the body, particularly the joints, heart, skin, and nervous system. It mainly affects children and young people. The features of rheumatic fever can include: painful, swollen joints, often affecting several joints and sometimes moving from one to another; fever; a rash; small painless lumps under the skin; inflammation of the heart (carditis), which is the most serious feature, as it can affect the heart, including the heart valves; and, in some, a movement disorder (Sydenham’s chorea) causing jerky, uncontrolled movements. The most important concern with rheumatic fever is its effect on the heart: inflammation of the heart valves can, particularly with repeated episodes, lead to long-term damage to the valves (rheumatic heart disease), which is the main serious consequence. Rheumatic fever is treated with medicines to treat the infection and reduce the inflammation and symptoms, and, importantly, with measures to prevent further episodes (which can cause more heart damage) — usually long-term antibiotics to prevent recurrent strep infections. Prevention of rheumatic fever in the first place relies on promptly and adequately treating strep throat infections with antibiotics. The key messages are that rheumatic fever is a rare immune reaction that can follow a strep throat infection, that its most serious effect is on the heart, and that treating strep throat infections, and preventing recurrences after an episode, are important.

How it is treated

Rheumatic fever is treated by managing the infection, reducing the inflammation and symptoms, and — importantly — preventing further episodes to protect the heart; and it is largely prevented by treating strep throat infections. If rheumatic fever is suspected — from the features (such as painful, swollen joints, fever, and other signs) developing a few weeks after a sore throat or strep infection, particularly in a child or young person — assessment is needed, and diagnosis is made from the clinical features along with tests (such as evidence of a recent strep infection, markers of inflammation, and assessment of the heart, including with an echocardiogram/ultrasound of the heart to check for carditis). Treatment involves several elements: antibiotics to clear any remaining strep infection; anti-inflammatory treatment (such as medicines to reduce the joint inflammation and pain, and, where the heart is significantly affected, other treatment) to manage the inflammation and symptoms; treatment for specific features (such as heart involvement or the movement disorder) as needed; and rest and supportive care during the acute illness. The most important long-term aspect is preventing further episodes of rheumatic fever, because recurrences can cause further, cumulative damage to the heart valves: this is done with long-term preventive antibiotics (usually regular antibiotic treatment continued for a prolonged period, sometimes years, as advised) to prevent recurrent strep infections and further episodes — this is a key part of care after rheumatic fever. Where the heart valves have been affected (rheumatic heart disease), ongoing monitoring and management of the heart are needed, and, in some cases, treatment for the valves (including surgery) may be required over time. Prevention of rheumatic fever in the first place is achieved by promptly and adequately treating streptococcal throat infections (and scarlet fever) with antibiotics, which prevents the immune reaction that leads to rheumatic fever — so seeking assessment and appropriate treatment for a significant sore throat, particularly where strep is suspected, is important, especially in areas or situations where rheumatic fever is more common. The reassuring messages are that rheumatic fever is now rare in the UK, that it is treatable — with treatment of the infection and inflammation, and, importantly, long-term preventive antibiotics to prevent recurrences and protect the heart — and that treating strep throat infections helps prevent it in the first place; while its main serious consequence (heart valve damage) means that protecting the heart, through preventing recurrences and monitoring, is a key focus.