Acute rheumatic fever and rheumatic heart disease
What are acute rheumatic fever and rheumatic heart disease?
Acute rheumatic fever (ARF) – commonly called rheumatic fever – is the body’s immune system reacting to an untreated infection with bacteria called Group A Streptococcus (GAS).
GAS commonly causes throat infection and some skin infections. GAS are found everywhere, but are more common where people live closely together.
ARF is an illness that can affect the skin, joints, brain and heart. The skin, joints and brain recover from ARF, but the heart can suffer lasting damage.
The lasting heart damage that remains after an episode of ARF is called rheumatic heart disease (RHD). This generally affects the heart valves which cause the heart not to pump blood properly. Read more about how your heart works.
- GAS is a family of germs that can cause infections all over the body. It can cause mild illness such as strep throat and impetigo (skin sores), but occasionally can cause serious or even life threatening disease.
- Long-acting bicillin (LAB) is a pencillin antibiotic that, when injected into the muscle, fights off infection for up to 28 days. This medicine is used to prevent further infections with GAS.
How do you get ARF?
Most commonly, ARF follows an untreated throat infection called strep throat caused by GAS germs.
The germs can cause the person’s immune system to fight against its own body tissues (autoimmune response), and in some susceptible people it can lead to ARF.
Remember – strep throat infections are contagious, but ARF is not.
How do you develop RHD?
Severe episodes of ARF can lead to permanent damage to the heart valves.
Repeat episodes of ARF can further damage the heart valves and lead to RHD getting worse.
When the heart valves are damaged, they can affect the heart’s ability to pump blood properly around the body.
This may lead to breathlessness and tiredness and reduce your ability to do some activities.
Who is most at risk?
ARF is relatively rare in industrialised countries, but in Australia it is a significant illness among Aboriginal people and Torres Strait Islanders, particularly across areas of central and northern Australia.
Anyone can be infected with GAS, but children aged 5 to 14 are most at risk of getting ARF.
Although rare, recurrences of this illness can occur into a person's 40s.
Signs and symptoms
Signs and symptoms may appear 2 to 3 weeks following a sore throat (strep throat) and may include:
- sore or swollen joints (knees, elbows, ankles, wrist)
- skin rash, particularly over the trunk area which can be difficult to see on some dark skin colors
- skin nodules
- jerky movements which can involve one or both arms, legs, head or mouth – this is called Sydenham’s chorea.
In more severe cases of ARF, inflammation of the heart (carditis) may develop and present as tiredness and breathlessness.
All symptoms will gradually resolve over several weeks to months, except sometimes permanent damage will occur to the heart valves.
Each repeat episode of ARF can lead to progressive damage to the heart. This is rheumatic heart disease (RHD). When the damage to the heart valves is severe, surgery may be required to repair or replace the faulty heart valves.
How do I know I have ARF?
Currently there is no test to determine if you have ARF. Health care professionals will use the information you provide and results from blood and throat swab tests to make a diagnosis.
Your doctor may order a special heart test called an echocardiogram which will determine if there is damage to the heart or its valves.
See your doctor or go to hospital as soon as possible if you suspect you have ARF. Early recognition and prompt treatment is necessary to prevent further damage to your heart which can lead to RHD.
ARF is a notifiable disease. This means doctors, nurse practitioners and hospitals must inform the Department of Health of your diagnosis. Notification is confidential.
Department of Health staff may talk to you or your doctor to find out how the infection occurred.
Treatment of ARF
If doctors think you have ARF, you will most likely be sent to hospital as soon as possible after your symptoms have started.
In most cases, your treatment will involve:
- Antibiotic medication to stop the infection. LAB injections are started as soon as possible after diagnosis of ARF to prevent further GAS infections. This treatment aims to prevent further episodes of ARF and reduce the risk of permanent heart damage (RHD). It is important injections are given at least every 28 days. You will need to continue this for at least 10 years or until you turn 21 – whichever is longer. Your heart doctor (cardiologist) will determine how long you should continue to receive penicillin injections.
- Medicines to stop pain in your joints.
- Bed rest may be necessary if symptoms are severe.
If left untreated
People who have had ARF are more susceptible to repeat ARF episodes if they have other GAS infections. Each episode of ARF can damage the heart valves, which can lead to:
- lifelong health problems
- a need for heart surgery
- early death.
While you have ARF or RHD
It is important to have your LAB injections every 28 days until your doctor says you can stop. You must keep your appointments with specialist doctors who will monitor the effects the disease has on your heart.
It is very important to keep your teeth and gums healthy as this will help you to prevent germs getting into your body and blood stream (which could damage your heart valves further).
See a dentist at least once a year and tell them you have ARF or RHD. You may need to take medicine before certain dental procedures to protect the heart from germs that can damage the heart further.
How can ARF and RHD be prevented?
People most at risk should have all throat and skin infections checked and treated as soon as possible by a health professional. Antibiotics may be prescribed to treat the GAS infection.
Once you have had ARF, having regular penicillin injections (LAB) at least every 28 days is the best way to prevent repeat episodes of ARF. This will also prevent long-term damage to the heart valves.
Regular medicine can also prevent any existing damage to the heart valves (RHD) from getting worse.
Where to get help
- ARF and RHD are preventable.
- Strep throats and skin sores should be treated with medicines to kill the GAS germs in high risk groups.
- ARF may cause long term damage to the heart and its valves.
- The best way to prevent repeat episodes of ARF and prevent further damage to heart valves is by having penicillin injections every 3 to 4 weeks.
- Seek medical advice as soon as possible if you suspect you may have ARF so treatment can be commenced early.
WA Rheumatic Heart Disease Register and Control Program
This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.